TY - JOUR
T1 - Bleb vascularity following post-trabeculectomy subconjunctival bevacizumab
T2 - A pilot study
AU - Chua, Brian E.
AU - Nguyen, Dan Q.
AU - Qin, Queena
AU - Ruddle, Jonathan B.
AU - Wells, Anthony P.
AU - Niyadurupola, Nuwan
AU - Gupta, Viney
AU - Wong, Tina T.
AU - Coote, Michael A.
AU - Crowston, Jonathan G.
PY - 2012/11
Y1 - 2012/11
N2 - Background: To determine whether postoperative subconjunctival bevacizumab significantly alters bleb vascularity. Design: A randomized, prospective interventional study. Participants: Forty-three eyes from 39 patients were recruited, with 21 eyes randomized to subconjunctival injections of 5-fluorouracil, and 22 eyes to combined 5-fluorouracil/bevacizumab. Methods: All patients who underwent uncomplicated primary antimetabolite augmented trabeculectomy who subsequently required postoperative subconjunctival 5-fluorouracil injection within 4 weeks of surgery were eligible. Patients were randomized to receive subconjunctival 5-fluorouracil only (7.5mg/0.15mL) or 5-fluorouracil plus bevacizumab (1.25mg/0.05mL). Main Outcome Measures: Primary outcome was bleb vascularity with secondary endpoints including visual acuity, intraocular pressure, bleb morphology, complications and total numbers of 5-fluorouracil injections were recorded at baseline, week 12 and 18 months. Results: At week 12, there was no significant difference between groups for visual acuity, intraocular pressure, bleb vascularity and morphology, or total number of 5-fluorouracil injections. By 18 months, 47.4% of the 5-fluorouracil/bevacizumab group exhibited central bleb avascularity compared with 21.1% of the 5-fluorouracil group (Fisher's exact test, P=0.17). Two bleb complications (one blebitis; one suture abscess) recorded in the 5-fluorouracil/bevacizumab group. Conclusions: After a single combined injection, a trend for increased central bleb avascularity was observed, although this effect was not sufficient to reach statistical significance. This, in addition to the occurrence of two bleb-related complications in the bevacizumab group, suggests the need for a larger clinical trial to further evaluate the safety and efficacy of bevacizumab as a modulating agent in glaucoma filtration surgery.
AB - Background: To determine whether postoperative subconjunctival bevacizumab significantly alters bleb vascularity. Design: A randomized, prospective interventional study. Participants: Forty-three eyes from 39 patients were recruited, with 21 eyes randomized to subconjunctival injections of 5-fluorouracil, and 22 eyes to combined 5-fluorouracil/bevacizumab. Methods: All patients who underwent uncomplicated primary antimetabolite augmented trabeculectomy who subsequently required postoperative subconjunctival 5-fluorouracil injection within 4 weeks of surgery were eligible. Patients were randomized to receive subconjunctival 5-fluorouracil only (7.5mg/0.15mL) or 5-fluorouracil plus bevacizumab (1.25mg/0.05mL). Main Outcome Measures: Primary outcome was bleb vascularity with secondary endpoints including visual acuity, intraocular pressure, bleb morphology, complications and total numbers of 5-fluorouracil injections were recorded at baseline, week 12 and 18 months. Results: At week 12, there was no significant difference between groups for visual acuity, intraocular pressure, bleb vascularity and morphology, or total number of 5-fluorouracil injections. By 18 months, 47.4% of the 5-fluorouracil/bevacizumab group exhibited central bleb avascularity compared with 21.1% of the 5-fluorouracil group (Fisher's exact test, P=0.17). Two bleb complications (one blebitis; one suture abscess) recorded in the 5-fluorouracil/bevacizumab group. Conclusions: After a single combined injection, a trend for increased central bleb avascularity was observed, although this effect was not sufficient to reach statistical significance. This, in addition to the occurrence of two bleb-related complications in the bevacizumab group, suggests the need for a larger clinical trial to further evaluate the safety and efficacy of bevacizumab as a modulating agent in glaucoma filtration surgery.
KW - Bevacizumab
KW - Bleb vascularity
KW - Glaucoma
KW - Trabeculectomy
KW - Vascular endothelial growth factor
UR - http://www.scopus.com/inward/record.url?scp=84869096870&partnerID=8YFLogxK
U2 - 10.1111/j.1442-9071.2012.02798.x
DO - 10.1111/j.1442-9071.2012.02798.x
M3 - Article
C2 - 22429268
AN - SCOPUS:84869096870
SN - 1442-6404
VL - 40
SP - 773
EP - 779
JO - Clinical and Experimental Ophthalmology
JF - Clinical and Experimental Ophthalmology
IS - 8
ER -