Korean J Ophthalmol.  2010 Feb;24(1):47-52. 10.3341/kjo.2010.24.1.47.

Subconjunctival Bevacizumab as an Adjunct to Trabeculectomy in Eyes with Refractory Glaucoma: A Case Series

• Choi JY
• Choi J
• Kim YD

• KMID: 1098794
• DOI: http://doi.org/10.3341/kjo.2010.24.1.47

Abstract

This prospective observational case series study included 6 eyes of 6 consecutive glaucomatous patients. Each patient underwent trabeculectomy with mitomycin C, and received a 1.25 mg of subconjunctival bevacizumab injection at completion of the trabeculectomy. Study eyes included two with neovascular glaucoma, three with uveitic glaucoma, and one with secondary glaucoma following vitrectomy. All eyes had undergone failed glaucoma laser/surgical treatment or an intraocular surgical procedure. Intraocular pressure (IOP) at the following postoperative visits: preoperative, 1 week, 1 month, 2 months, 3 months, and 6 months, was measured. We also evaluated postoperative bleb findings and complications. IOP measured at each visit was 37.5+/-14.4 mmHg, 6.2+/-3.4 mmHg, 8.3+/-7.2 mmHg, 12.0+/-4.4 mmHg, 10.8+/-3.1 mmHg, and 12.2+/-3.3 mmHg, respectively, for each visit. All eyes had functioning blebs with normal IOP at postoperative 6 months with no additional IOP-lowering medication.

Keyword

Angiogenesis Inhibitors; Glaucoma; Monoclonal antibodies; Trabeculectomy; Vascular endothelial growth factors

MeSH Terms

Adult
Aged
Angiogenesis Inhibitors/*administration & dosage
Antibodies, Monoclonal/*administration & dosage
Conjunctiva
Female
Glaucoma/*drug therapy/etiology/*surgery
Glaucoma, Neovascular/drug therapy/surgery
Humans
Injections, Intraocular
Male
Middle Aged
Prospective Studies
Trabeculectomy/*methods
Uveitis/complications
Vascular Endothelial Growth Factor A/*antagonists & inhibitors
Vitrectomy/adverse effects

Figure

• 

  Fig. 1 Intraocular pressure (IOP) changes following trabeculectomy plus subconjunctival bevacizumab administration.

• 

  Fig. 2 Representative postoperative slit lamp photographs. (A) Case 1. Localized avascular bleb formation in an eye with neovascular glaucoma (NVG). (B) Case 2. Localized bleb formation in the superior area in an eye with NVG. Note the presence of previously failed trabeculectomy in the superonasal and super-otemporal areas. (C) Case 3. Localized avascular bleb formation in an eye with uveitic glaucoma. (D) Case 4. Diffuse and low bleb formation in an eye with uveitic glaucoma. Note the presence of a previously failed Ahmed drainage device in the superotemporal area. (E) Case 5. Localized avascular bleb formation in an eye with secondary glaucoma following retinal detachment surgery. Note the presence of the anchoring suture of the scleral buckle in the superotemporal subconjunctival area. (F) Case 6. Wound revision at 1 month after trabeculectomy in Case 6 revealed the absence of blood vessel formation or wound adhesion around the scleral flap.

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