Trabeculectomy with mitomycin C alone or coupled with intracamerular bevacizumab? A 2-year comparative study.
José Patrícia, Teixeira Filipa Jorge, Barão Rafael, Sousa David Cordeiro, Marques Raquel Esteves, Barata Andre Diogo De Oliveira, Marques-Neves Carlos, Alves Marta, Papoila Ana Luísa, Stalmans Ingeborg
AI Summary
This study found adding intracamerular bevacizumab to trabeculectomy with MMC significantly improved absolute success rates and achieved lower IOPs, particularly useful for patients needing very low target pressures.
Abstract
Purpose
To compare outcomes of primary trabeculectomy using either mitomycin C (MMC) alone versus MMC augmented with intracamerular bevacizumab in patients with open-angle glaucoma.
Methods
Retrospective, cohort, two-centre, comparative study. Patients' data were screened between October 2015 and March 2019, with inclusion requiring a minimum follow-up of 24 months. Primary outcome was intraocular pressure (IOP) lowering at 24 months, with surgical success defined with different maximum IOP targets (≤18, ≤16 and ≤14 mm Hg) and at least 30% reduction and higher than 5 mm Hg. Absolute success was achieved if no IOP-lowering medication was needed and a qualified success if otherwise. Safety outcomes were analysed.
Results
A total of 110 eyes underwent trabeculectomy with MMC, 51 of these combined with intracamerular bevacizumab. Both strategies were effective in terms of IOP lowering (baseline vs 2 years postoperatively: 24.4 (8.0) mm Hg vs 12.1 (5.3) mm Hg in the MMC group; 25.1 (8.7) vs 10.8 (3.8) mm Hg in the MMC+bevacizumab group; p<0.001 in both comparisons). The MMC+bevacizumab group had a significant difference towards higher efficacy on absolute success rates at all targets (IOP≤14 or ≤16 or ≤18 mm Hg; p=0.010, p=0.039 and p=0.007, respectively). The large majority (93%) of the MMC+bevacizumab group was drop-free at 24 months, and 41% had IOP below 10 mm Hg. Complication rates were low and similar between groups, with no systemic adverse events.
Conclusions
Intracamerular bevacizumab in MMC-augmented primary trabeculectomy increases the chances of obtaining low IOP outcomes. This strategy may be useful when planning for surgeries aiming at target pressures in the low teens.
Trial registration number: ISRCTN93098069.
MeSH Terms
Shields Classification
Key Concepts5
Primary trabeculectomy with mitomycin C alone or coupled with intracamerular bevacizumab effectively lowered intraocular pressure (IOP) in patients with open-angle glaucoma, with baseline IOP of 24.4 (8.0) mm Hg reducing to 12.1 (5.3) mm Hg in the mitomycin C alone group and 25.1 (8.7) mm Hg reducing to 10.8 (3.8) mm Hg in the mitomycin C + bevacizumab group at 2 years postoperatively (p<0.001 in both comparisons).
The combination of intracamerular bevacizumab with mitomycin C-augmented primary trabeculectomy resulted in significantly higher absolute success rates at all maximum IOP targets (IOP≤14, ≤16, or ≤18 mm Hg) compared to mitomycin C alone in patients with open-angle glaucoma (p=0.010, p=0.039, and p=0.007, respectively).
93% of patients in the mitomycin C + intracamerular bevacizumab group were drop-free (no IOP-lowering medication needed) at 24 months after primary trabeculectomy for open-angle glaucoma.
41% of patients in the mitomycin C + intracamerular bevacizumab group achieved an intraocular pressure (IOP) below 10 mm Hg at 24 months after primary trabeculectomy for open-angle glaucoma.
Complication rates were low and similar between primary trabeculectomy with mitomycin C alone and primary trabeculectomy with mitomycin C augmented with intracamerular bevacizumab, with no systemic adverse events observed in patients with open-angle glaucoma.
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