Avastin less effective than MMC as adjunct to trabeculectomy

Because vascular endothelial growth factor (VEGF) is an important stimulus for wound healing and may induce fibroblast proliferation, the authors of this study compared the efficacy of anti-VEGF agent bevacizumab with the more commonly used adjunctive applied with trabeculectomy, mitomycin C (MMC). They found that bevacizumab was effective, but the reduction in 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 had decreased by a mean of 34 percent in the bevacizumab group and 56 percent in the MMC group. Additionally, the bevacizumab group required more anti-glaucoma medications for IOP control compared with the MMC group, although this difference was not statistically significant. There was no difference observed in terms of bleb morphologic features.

Although fewer patients in the bevacizumab group achieved complete success, defined as an IOP of 21 mm Hg or less and at least 20 percent unmedicated reduction in preoperative pressure, this group had a 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 for 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.