Evaluation of topical bevacizumab as an adjunct to mitomycin C augmented trabeculectomy

PURPOSE: To investigate the safety and synergistic effect of topical bevacizumab after trabeculectomy surgery with mitomycin C (MMC). METHODS: In this prospective, non-randomized, comparative interventional study, 40 eyes from 40 patients with uncontrolled open-angle glaucoma were studied after they underwent primary trabeculectomy with mitomycin C (0.02% for 2 min). Following the procedure topical bevacizumab (4 mg/mL) was used for 2 weeks 4 times daily in group A. Patients in group B received routine postoperative care. The outcome measures were the intraocular pressure (IOP), number of anti-glaucoma medications, complications, and bleb evaluation. RESULTS: Of the 32 eyes that had at least 6 months follow-up, 16 were treated with adjuvant topical bevacizumab. The mean preoperative IOP in group A improved from 26.7 ± 9.3 mmHg with 2.8 ± 1.3 anti-glaucoma medications to 10.5 ± 2.8 mmHg with 0.7 ± 1 anti-glaucoma medications at last follow-up (P < 0.001). The mean preoperative IOP in group B improved from 21.8 ± 6.6 mmHg with 3 ± 0.8 anti-glaucoma medications to 11.4 ± 3.6 mmHg with 0.8 ± 1.2 anti-glaucoma medications at last follow-up (P < 0.001). There was an overall reduction of 54.4% and 43.7% in the IOP in groups A and B, respectively (P = 0.18). The cystic type of bleb was less common in group A (P = 0.043). One patient in group A developed a streptococcal corneal ulcer 1.5 months after surgery. CONCLUSION: Administration of topical bevacizumab 4 mg/ml for two weeks following trabeculectomy with mitomycin-C did not significantly affect the IOP trend, but significantly decreased the cystic bleb formation in short-term follow-up.