Per-operative use of anti-VEGF agents improves the chance of success of trabeculectomy

The Science behind the Tip

Anti-VEGF agents have been widely used in a variety of ocular diseases for their activity in decreasing blood vessel formation. In glaucoma surgery, these drugs' anti-angiogenic and anti-fibrotic properties have been suggested to play a role in inhibiting bleb vascularization and decreasing postoperative scarring (1).

While research on the most suitable compound and its optimal route of administration are ongoing, the cumulative data from small-scale studies from several centers suggest inhibiting VEGF activity to be an attractive pathway in modulating wound healing in glaucoma surgery (2,3).

A prospective, randomized surgical trial in open-angle glaucoma patients has recently suggested that a single intracameral injection of bevacizumab (1.25mg/50µL) during trabeculectomy increases significantly the chances of success at 12 months (4).

Contributors: Luís Abegão Pinto and Ingeborg Stalmans

References:

1. Mathew R, Barton K. Anti-vascular endothelial growth factor therapy in glaucoma filtration surgery. Am J Ophthalmol 2011;152(1):10-5.e2.

2. Grewal DS, Jain R, Kumar H, Grewal SP. Evaluation of subconjunctival bevacizumab as an adjunct to trabeculectomy a pilot study. Ophthalmology 2008;115(12):2141-5.e2.

3. Kahook MY. Bleb morphology and vascularity after trabeculectomy with intravitreal ranibizumab: a pilot study. Am J Ophthalmol 2010;150(3):399-403.e1.

4. Vandewalle E, Abegão Pinto L, Van Bergen T, et al. Intracameral bevacizumab as an adjunct to trabeculectomy: a 1-year prospective, randomised study. Br J Ophthalmol 2014;98(1):73-8.

Tip Reviewer: Roger Hitchings
Tip Editors: John Salmon and Gordana Sunaric Mégevand