Glaucoma is the second leading cause of blindness globally. Although it is usually controlled with intraocular pressure (IOP)-lowering medications, surgical intervention becomes warranted in certain situations such as poor compliance with medications, progressive disease despite maximum medical therapy, or both. Trabeculectomy has been the most commonly performed surgical procedure in the management of uncontrolled glaucoma for more than 3 decades (Quigley HA, 1996).
The success of trabeculectomy mainly is related to the control of postoperative scar formation at the site of bleb formation. Antimetabolite agents such as MMC and 5-fluorouracil have been used widely adjunctively with trabeculectomy for wound-healing modulation. Despite the favorable efficacy of these agents in treating the long-term outcome of trabeculectomy, (Crowston, 2008) they are associated with various complications such as toxicity to corneal endothelial cells, (Sihota et al., 1998) hypotony, blebitis and endophthalmitis (Lama and Fechtner,2003) .
Vascular endothelial growth factor (VEGF), which is an endothelial cell-specific mitogen and an angiogenic inducer, has been found to be an important stimulus for wound healing (Li et al, 2003). In addition to its antiangiogenic properties, there is histologic evidence indicating that VEGF induces fibroblast proliferation (Sun et al,2004). Li and associates showed that VEGF increases in the aqueous humor of patients with glaucoma. They also demonstrated that fibroblast proliferation and scar formation have been decreased by administration of anti-VEGF agents at the site of the trabeculectomy. One of the most commonly used anti-VEGF agents in the context of ocular disease with a vascular component is bevacizumab. It is a humanized, nonselective monoclonal antibody against VEGF (Li et al, 2009). |
