Avastin less effective than MMC as adjunct to trabeculectomy

Because vascular endothelial growth factor (VEGF) is an important stimulus for wound healing and may possibly induce fibroblast proliferation, the authors of this study compared the efficacy of anti-VEGF agents with the more commonly used adjunctive applied with trabeculectomy, mitomycin C (MMC). They found that bevacizumab was effective, but the reduction of IOP was greater with MMC.

Subjects in this prospective study were 34 patients (36 eyes) with uncontrolled glaucoma randomized to trabeculectomy with adjunctive subconjunctival bevacizumab or mitomycin C (0.02% for three minutes).

At a mean follow-up of about seven months, IOP decreased by a mean of 34 percent in the bevacizumab group and by 56 percent in the MMC group. Additionally, the bevacizumab group required more antiglaucoma medications for IOP control compared with the MMC group, although this difference was not statistically significant. And there was no difference observed in terms of bleb morphologic features.

Although the bevacizumab group had less complete success, defined as an IOP of 21 mm Hg or less and at least 20 percent unmedicated reduction in preoperative pressure, it had greater cumulative probability of total success (100% vs. 94.4%).

The authors conclude that intraoperative subconjunctival bevacizumab in association with trabeculectomy is safe and effective in terms of IOP control. Although it is costly, they note that additional injections of bevacizumab after surgery may improve the result of trabeculectomy to the level observed after treatment with MMC.