%0 Journal Article
%T Subconjunctival Bevacizumab Injection in Glaucoma Filtering Surgery: A Case Control Series
%A Jing Wang
%A Paul Harasymowycz
%J ISRN Ophthalmology
%D 2013
%R 10.1155/2013/384134
%X Aims. To describe the use of subconjunctival bevacizumab (SCB) injection in the combined cataract and glaucoma filtering surgery (GFS). Methods. Retrospective comparative case series. Thirty eyes of twenty-eight patients who had GFS followed by SCB injection as part of post-operative management were included (Group SCB). The types of GFS included trabeculectomy and non-penetrating glaucoma surgery (NPGS) with mitomycin-C. Outcome measures included the reduction of intraocular pressure (IOP) and medications. Age-matched patients who had the same types of surgery without SCB were selected as a control group (Group C). Results. The types of GFS were: combined cataract surgery and NPGS (SCB: 20; C: 24), phacotrabeculectomy (SCB: 6; C: 3), NPGS (SCB: 3; C: 2) and trabeculectomy alone (SCB: 1; C: 1). The average follow-up time was 16.9 (¡À8.2) months in the SCB group and 19.6 (¡À11.5) months in the controls. 1.25£¿mg of bevacizumab was injected on average 14.1 (range: 3¨C42) days post-GFS. The mean IOP decreased from 21.9 (¡À9.8) to 11.9 (¡À4.7) mmHg in the controls and from 19.6 (¡À8.9) to 14.0 (¡À4.7) mmHg in the SCB group. There was no statistically significant difference between the two groups ( ). Complications included three cases of branch vein occlusion in the SCB group. Conclusions. SCB did not result in better outcome in term of IOP reduction. Clinicians should monitor its side effects in glaucoma patients. 1. Introduction A key determinant of a successful glaucoma filtering surgery (GFS) is the healing response of the sclera, Tenon tissue, and conjunctiva. Histologically, functional blebs show low inflammatory response with scattered conjunctival epithelium cells and fibroblasts, whereas dysfunctional blebs are characterized by dense collagen tissues and corkscrew blood vessels [1]. Agents that modify the healing process have been used to improve the success of GFS. Antiproliferative agents such as 5-fluoroacil (5-FU) and mitomycin-C (MMC) inhibit the proliferation of fibroblasts. Both intraoperative use and postoperative use of these two agents have significantly improved the success of GFS, especially in high-risk patients [2]. However, the use of these antiproliferative agents can lead to very thin blebs that are prone to leakage, hypotony, and higher incidence of endophthalmitis [3, 4]. Other modulating agents such as growth factors inhibitors have been investigated for their potential use in GFS. Among these, antitransforming growth factor- (TGF- ) has shown promising results in experimental studies but has failed to show any superiority to placebo
%U http://www.hindawi.com/journals/isrn.ophthalmology/2013/384134/