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Study: Ranibizumab and topical MMC produce better trabeculectomy outcomes than MMC alone
Am J Ophthalmol. 2010;150(3):399-403.
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Combination intravitreal ranibizumab and topical mitomycin C during trabeculectomy surgery resulted in slightly improved postoperative outcomes when compared to stand-alone MMC therapy, a study showed.
In the prospective, randomized, single-site pilot study, 10 primary open-angle glaucoma patients received either a 0.5-mg dose of Lucentis (ranibizumab, Genentech) and MMC (0.4 mg/mL applied topically for 2 minutes) or MMC alone.
At 6 months' follow-up, patients who received the combination anti-VEGF therapy had more diffuse blebs with a lower degree of vascularity.
However, both study groups exhibited significant differences in peripheral bleb area, peripheral bleb vascularity and nonbleb-related peripheral conjunctiva vascularity.
In addition, all patients were considered unqualified successes, with postoperative IOPs between 5 mm Hg and 22 mm Hg, representing a 30% decrease from baseline without use of postoperative hypotensive drops, according to the study.
"More long-term follow-up is needed to reveal IOP or success rate differences between the groups if they are to occur," the authors said. "Future studies should focus on investigating the effects of anti-VEGF agents as stand-alone wound modulators."
The current study has already been expanded to include more patients over a longer period of time, as well as a study arm featuring intravitreal ranibizumab therapy alone.
Utilization of mitomycin C and 5-fluorouracil in standard trabeculectomy is often recommended to prevent filtration failure. While improving surgical efficacy in regards to lowering IOP, these agents increase the rate of complications such as blebitis and endophthalmitis. Anti-VEGF agents also impact wound healing. In a prospective pilot study, Dr. Malik Kahook demonstrated that combining intravitreal ranibizumab and topical MMC at time of trabeculectomy resulted in more diffuse blebs with less vascularity when compared to use of topical MMC alone. Additional studies will further delineate the role of anti-VEGF agents in improving trabeculectomy outcomes.
– Steven D. Vold, MD
Boozman-Hof Eye
Clinic P.A., Rogers, Ark.