Trabeculectomy with MMC may be more effective at reaching lower IOP

Trabeculectomy with a subconjunctival injection of bevacizumab may be less effective in controlling IOP compared with primary trabeculectomy with mitomycin C, according to a study.

The prospective, randomized clinical study evaluated 42 patients with primary open-angle glaucoma who were randomized to receive either topical MMC or subconjunctival Avastin (bevacizumab, Genentech) during trabeculectomy.

Preoperatively, mean IOP was 23.9 mm Hg in the bevacizumab group; this decreased to 13.9 mm Hg at 12 months. Mean IOP was 22.9 mm Hg in the MMC group preoperatively and decreased to 12.2 mm Hg at 12 months. Both differences were statistically significant (P < .001).

In the bevacizumab group, patients used a mean of 2.6 glaucoma medications before surgery and a mean of 0.6 medications at 12 months. In the MMC group, patients used a mean of 2.7 medications before surgery and a mean of 0.1 medications at 12 months. Both differences were statistically significant (P < .001).

However, 15 eyes (71%) in the MMC group reached a target IOP of 12 mm Hg without medications while seven eyes (33%) in the bevacizumab group reached that target. The difference was statistically significant (P = .02).

Two patients in the MMC group and six patients in the bevacizumab group had an encapsulated bleb. The difference was not statistically significant.

Disclosure: The authors have no relevant financial disclosures.