This article is more than 5 years old. Information may no longer be current.
Intracameral anti-VEGF injection associated with success in trabeculectomy cases, study finds
Click Here to Manage Email Alerts
 Ingeborg Stalmans |
VIENNA, Austria — More glaucoma patients achieved target IOP without medication or postoperative surgical interventions when receiving bevacizumab than a placebo group, a prospective study found.
"A single intracameral injection of bevacizumab at the end of trabeculectomy was associated with increased absolute success rates and reduced need for postoperative interventions," Ingeborg Stalmans, MD, PhD, said at Glaucoma Day preceding the European Society of Cataract and Refractive Surgeons meeting here.
In the study, absolute success was defined as "meeting the target IOP without IOP-lowering medication or postoperative surgical interventions," which excluded massage and suture adjustment.
The prospective, randomized, placebo-controlled, double-masked study looked at the use of Avastin (bevacizumab, Genentech) for improved outcomes after trabeculectomy, including as an anti-scarring agent following surgery. The study included 141 patients with either primary open-angle glaucoma or normal tension glaucoma.
Patients were divided into two groups, with 70 patients receiving bevacizumab and undergoing trabeculectomy and 71 patients receiving a placebo and undergoing trabeculectomy with mitomycin C.
Follow-up was 6 months.
Bevacizumab 50 µl, 25 mg/mL was injected into the anterior chamber through hydrated paracentesis.
The study found that 83% of all patients in the bevacizumab group achieved absolute success, while 59% achieved absolute success in the placebo group.
"This was quite a striking difference, which was clearly statistically significant," she said.
- Disclosure: Dr. Stalmans has no relevant financial disclosures.
There has been increasing interest in the potential role of bevacizumab, not just in neovascular glaucoma but for its potential effect at inhibiting wound healing after trabeculectomy, and Dr. Stalman’s group has previously published an important study that demonstrated not only a benefit in an animal model, but also that aqueous VEGF levels are higher in glaucoma eyes than control eyes undergoing surgery.
The study Dr. Stalmans presented in Vienna builds on her previous work and demonstrates that a single intracameral injection of an anti-VEGF agent improves trabeculectomy success in comparison with placebo. How anti-VEGF agents will compare with mitomycin C is yet to be determined and whether or not they will prove useful in an adjunctive capacity.
– Keith Barton, MD, FRCP, FRCS
Moorfields
Eye Hospital, London
Disclosure: Dr. Barton has no relevant financial
disclosures.
References:
- Mathew R, Barton K. Anti-vascular endothelial growth factor therapy in glaucoma filtration surgery. Am J Ophthalmol. 2011;152:10-15.
- Li Z, Van Bergen T, Van de Vel I, et al. Inhibition of vascular endothelial growth factor reduces scar formation after glaucoma filtration surgery. Invest Ophthalmol Vis Sci. 2009;50:5217-5225.