Intracameral bevacizumab as an adjunct to trabeculectomy
Reviewed by Jonathan Chan

This is a 12-month, prospective, randomised, double-masked, placebo-controlled trial of patients who were not controlled medically with open angle glaucoma and scheduled for a primary trabeculectomy. Patients were recruited and randomised during the period between April 2009 and November 2010. In the study group patients received 50µL of either bevacizumab (1.25mg) or placebo balanced salt solution (BSS) peroperatively. The success was defined as intraocular pressure (IOP) ≤18mmHg and >5mmHg with at least 30% reduction from baseline and no loss of light perception. There were 138 patients who completed a 12-month follow-up cycle and of those 69 were in the bevacizumab treated group. The intraocular pressures were measured at one year postoperatively and found to be significantly lower than baseline (placebo: 25.6±9.9mmHg vs. 11.5 ≤3.9mmHg, p<0.01; bevacizumab: 24.8±8.1mmHg vs. 11.9±3.8mmHg, p<0.01) with no difference between treatment groups (p=0.69). It was found that the absolute success was higher in the bevacizumab group (71% vs. 51%) with the need for lowering of the intraocular pressure interventions (needlings) being lower in this group (12% vs 33%). The surgical technique used was by injecting either the study medication (50µL bevacizumab at a concentration of 25mg/mL) or placebo (BSS) solution intracamerally through the paracenteses using a single-use 30-gauge needle. At the end of the procedure, a subconjunctival injection of betamethasone was administered. Topical preparations containing tobramycin and dexamethasone were used as an ointment and then continued four times a day for eight weeks duration. The authors commented that the limitation of this study concerns the inclusion of patients scheduled for trabeculectomy with or without mitomycin C (MMC) use. The authors commented that the standard at the centre for patients without risk of scarring involved the use of MMC only if a low target pressure was deemed necessary. A post-hoc analysis revealed that despite no significant differences in the primary outcome at the 12-month period, bevacizumab could still significantly improve the survival curve in both subgroups (with or without MMC use). The authors concluded that intracameral bevacizumab significantly reduces the need for additional interventions during the follow-up of patients undergoing primary trabeculectomy procedure.

Intracameral bevacizumab as an adjunct to trabeculectomy: a 1-year prospective, randomised study.
Vandewalle E, Pinto LA, Van Bergen T, et al.
BRITISH JOURNAL OF OPHTHALMOLOGY
2014;98:73-8.