Subconjunctival Bevacizumab to Augment Trabeculectomy with Mitomycin-C in Management of Failed Glaucoma Surgery
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Purpose • To provide a feasible solution to the problem of .failed glaucoma surgery. The aim was to evaluate the efficacy and safety of the additional effects of a combined surgical approach. This approach augments trabeculectomy with mitomycin-C (MMC} application by subconjunctival bevacizumab injection. The results were compared to those of trabeculectomy with only adjunctive MMC. Methods • Controlled randomized prospective clinical trial included 28 eyes diagnosed with failed scarred bleb of a previous trabeculectomy. They were divided into two equal groups: the combined group A 'trabeculectomy with adjunctive MMC and subconjunctival bevacizumab' and control group B 'trabeculectomy with adjunctive MMC only'. The main outcome results included cumulative probability of surgical success, Infra ocular pressure (10P) values, number of 10P lowering medications needed to achieve the target 10P. Results • Group A achieved a cumulative probability of complete success of 0.769 and qualijied success of 0..231 at the end of the 24months study period, however group B achieved 0.538 and 0.308 respectively. Group A succeeded to achieve a lower mean 10P values than group B with less antiglaucoma drugs at all postoperative visits, but not to the statistically significant level (p>0.05). There was no statistically significant difference between both groups regarding best corrected visual acuity, visual field parameters, operative and/or postoperative complications, and additional interventions. No significant adverse effects were caused by this combined approach. Conclusion: Bevacizumab was not found to add much to the favorable long-term outcome of conventional trabeculectomy with MMC as a solution to the problem of scarred jailed bleb. No financial disclosure. Key words: glaucoma- bevacizumab- mitomycin-C -failed trabeculectomy- bleb failure- scarred bleb.