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. |
