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TOPLINE:

Compared with placebo, intravitreal bevacizumab administered as a single intraoperative dose during trabeculectomy with mitomycin C was associated with more durable surgical success over 3 years and a reduced need for topical intraocular pressure-lowering eye drops.

METHODOLOGY:

• Researchers conducted a 3-year follow-up study of a clinical trial to test whether a single intravitreal injection of bevacizumab during trabeculectomy continued to improve surgical success.
• Between July 2016 and September 2018, 131 patients who needed primary or redo trabeculectomy or phacotrabeculectomy for progressive glaucoma were enrolled and randomly assigned to receive a single intraoperative intravitreal injection of bevacizumab (n = 65; mean age, 77.7 years; 56.9% male) or placebo (n = 66; mean age, 74.1 years; 42.4% male) during standardized trabeculectomy with mitomycin C.
• Overall, 111 patients completed 36 months of follow-up.
• Each participant’s target intraocular pressure was set using their visual field score and preoperative intraocular pressure; intraocular pressure and visual acuity were measured at day 1, 1 week, 1 month, 2 months, 3 months, 6 months, 12 months, and 36 months postoperatively.
• The primary outcome was treatment success, defined as complete success when the intraocular pressure was less than or equal to the predefined target without the need for topical medication or qualified success when topical medication was required to meet the predefined target threshold for intraocular pressure.

TAKEAWAY:

• At 36 months postoperatively, significantly more patients who received bevacizumab achieved complete success (92.3% vs 71.2%; P = .001) and qualified success (98.5% vs 89.4%; P = .03) than those who received placebo.
• Treatment with bevacizumab was associated with an 83% lower risk for failure to achieve complete success (hazard ratio [HR], 0.17; P = .002) and a 93% lower risk for failure to achieve qualified success (HR, 0.07; P = .03).
• Female vs male sex (HR, 0.23; P = .002) and primary vs redo trabeculectomy (HR, 0.28; P = .04) were associated with a lower risk for failure to achieve complete success.
• Fewer patients who received intraoperative bevacizumab vs placebo required topical intraocular pressure-lowering drops at most postoperative visits, with statistically significant differences at 3 months (P = .008), 6 months (P = .009), 12 months (P = .007), and 36 months (P < .005).

IN PRACTICE:

“The current data demonstrate that the effects of bevacizumab on surgical success were not short-lived and persisted at 36 months,” the researchers of the study reported.

SOURCE:

The study was led by John Landers, Department of Ophthalmology, Flinders University Medical Research Institute, Adelaide, South Australia. It was published online on May 14 in Ophthalmology.

LIMITATIONS:

It was uncertain whether the benefits of bevacizumab applied to all types of glaucoma. Another limitation was the uncertainty about how bevacizumab acts in different ocular compartments. More patients in the bevacizumab group had combined cataract surgery and trabeculectomy.

DISCLOSURES:

The study received funding from an Early Career STEM Professional Grant provided by Science Excellence Awards SA and a National Health and Medical Research Council Practitioner Fellowship. The authors disclosed having no proprietary or financial interests related to the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.