The efficacy of adjunctive mitomycin C and/or anti-VEGF agents on glaucoma tube shunt drainage device surgeries: a systematic review.
Figueiredo Raquel, Barbosa-Breda Joao
AI Summary
This review found limited evidence for adjunctive MMC in glaucoma tube shunts, but bevacizumab may benefit neovascular glaucoma patients, particularly with PRP.
Abstract
Purpose
The effectiveness of mitomycin C (MMC) in trabeculectomy has long been established. The aim of this review is to evaluate the efficacy and safety of adjunctive agents in tube shunt drainage device surgery for glaucoma or ocular hypertension, since controversy still exists regarding their benefit.
Methods
We searched CENTRAL, PubMed, Embase, Web of Science, Scopus, and BASE for RCTs, which have used adjuvant antimetabolites-either MMC or 5-Fluorouracil (5-FU)-and/or anti-vascular endothelial growth factors (anti-VEGF) agents. The main outcome was IOP reduction at 12 months.
Results
Ten studies met our inclusion criteria. Nine used the Ahmed Glaucoma Valve (AGV) implant, while the double-plate Molteno implant was used in one study. Four studies used MMC. The remaining six studies used an anti-VEGF drug - either bevacizumab, ranibizumab or conbercept. Only one MMC-study reported a significant difference in the IOP reduction between groups at 12 months, favouring the MMC group (55% and 51%; p < 0.01). A significant difference was also reported by two out of five bevacizumab-studies, both favouring the bevacizumab group (55% and 51%, p < 0.05; 58% and 27%, p < 0.05), with the highest benefit seen in neovascular glaucoma cases, especially when panretinal photocoagulation (PRP) was also used. Neither ranibizumab nor conbercept were found to produce significant differences between groups regarding IOP reduction.
Conclusion
There is no high-quality evidence to support the use of MMC in tube shunt surgery. As for anti-VEGF agents, specifically bevacizumab, significant benefit seems to exist in neovascular glaucoma patients, especially if combined with PRP.
MeSH Terms
Shields Classification
Key Concepts5
A systematic review of 10 studies found no high-quality evidence to support the use of mitomycin C (MMC) in glaucoma tube shunt surgery.
A systematic review of 10 studies found that bevacizumab, an anti-VEGF agent, showed significant benefit in neovascular glaucoma patients undergoing tube shunt surgery, especially when combined with panretinal photocoagulation (PRP).
Neither ranibizumab nor conbercept, anti-VEGF agents, were found to produce significant differences between groups regarding IOP reduction in glaucoma tube shunt surgery, according to a systematic review of 10 studies.
One study included in a systematic review reported a significant difference in IOP reduction at 12 months favoring the mitomycin C (MMC) group (55% vs 51%, p < 0.01) in glaucoma tube shunt surgery.
Two out of five studies on bevacizumab, included in a systematic review, reported significant differences in IOP reduction at 12 months favoring the bevacizumab group (55% vs 51%, p < 0.05; and 58% vs 27%, p < 0.05) in glaucoma tube shunt surgery.
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