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Subconjunctival bevacizumab to augment trabeculectomy with mitomycin C in the management of failed glaucoma surgery

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 the application of trabeculectomy with mitomycin C (MMC) by adding subconjunctival beva...

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Autores principales: Saeed, Ahmed M, AboulNasr, Tarek Tawfeek
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168860/
https://www.ncbi.nlm.nih.gov/pubmed/25246758
http://dx.doi.org/10.2147/OPTH.S67730
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author Saeed, Ahmed M
AboulNasr, Tarek Tawfeek
author_facet Saeed, Ahmed M
AboulNasr, Tarek Tawfeek
author_sort Saeed, Ahmed M
collection PubMed
description 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 the application of trabeculectomy with mitomycin C (MMC) by adding subconjunctival bevacizumab injection. The results were compared with those of trabeculectomy with only adjunctive MMC. METHODS: A randomized controlled prospective clinical trial included 28 eyes diagnosed with failed scarred bleb of a previous trabeculectomy. The eyes were divided into two equal groups: combined group A, “trabeculectomy with adjunctive MMC and subconjunctival bevacizumab,” and control group B, “trabeculectomy with adjunctive MMC only.” The main outcome results included the cumulative probability of surgical success, intraocular pressure (IOP) values, and number of IOP-lowering medications needed to achieve the target IOP. RESULTS: Group A achieved a cumulative probability of complete success of 0.769 and of qualified success of 0.231 at the end of the 24 month study period; group B achieved cumulative probabilities of 0.538 and 0.308, respectively. Group A achieved a lower mean IOP value than group B, with fewer antiglaucoma drugs at all postoperative visits, but this lower value did not reach a 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 failed bleb.
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spelling pubmed-41688602014-09-22 Subconjunctival bevacizumab to augment trabeculectomy with mitomycin C in the management of failed glaucoma surgery Saeed, Ahmed M AboulNasr, Tarek Tawfeek Clin Ophthalmol Original Research 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 the application of trabeculectomy with mitomycin C (MMC) by adding subconjunctival bevacizumab injection. The results were compared with those of trabeculectomy with only adjunctive MMC. METHODS: A randomized controlled prospective clinical trial included 28 eyes diagnosed with failed scarred bleb of a previous trabeculectomy. The eyes were divided into two equal groups: combined group A, “trabeculectomy with adjunctive MMC and subconjunctival bevacizumab,” and control group B, “trabeculectomy with adjunctive MMC only.” The main outcome results included the cumulative probability of surgical success, intraocular pressure (IOP) values, and number of IOP-lowering medications needed to achieve the target IOP. RESULTS: Group A achieved a cumulative probability of complete success of 0.769 and of qualified success of 0.231 at the end of the 24 month study period; group B achieved cumulative probabilities of 0.538 and 0.308, respectively. Group A achieved a lower mean IOP value than group B, with fewer antiglaucoma drugs at all postoperative visits, but this lower value did not reach a 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 failed bleb. Dove Medical Press 2014-09-15 /pmc/articles/PMC4168860/ /pubmed/25246758 http://dx.doi.org/10.2147/OPTH.S67730 Text en © 2014 Saeed and AboulNasr. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Saeed, Ahmed M
AboulNasr, Tarek Tawfeek
Subconjunctival bevacizumab to augment trabeculectomy with mitomycin C in the management of failed glaucoma surgery
title Subconjunctival bevacizumab to augment trabeculectomy with mitomycin C in the management of failed glaucoma surgery
title_full Subconjunctival bevacizumab to augment trabeculectomy with mitomycin C in the management of failed glaucoma surgery
title_fullStr Subconjunctival bevacizumab to augment trabeculectomy with mitomycin C in the management of failed glaucoma surgery
title_full_unstemmed Subconjunctival bevacizumab to augment trabeculectomy with mitomycin C in the management of failed glaucoma surgery
title_short Subconjunctival bevacizumab to augment trabeculectomy with mitomycin C in the management of failed glaucoma surgery
title_sort subconjunctival bevacizumab to augment trabeculectomy with mitomycin c in the management of failed glaucoma surgery
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168860/
https://www.ncbi.nlm.nih.gov/pubmed/25246758
http://dx.doi.org/10.2147/OPTH.S67730
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