Short-Term Results of Sutureless Scleral Tunnel Trabeculectomy Using Adjunctive Topical Bevacizumab
Medical hypothesis discovery and innovation in ophthalmology,
Vol. 7 No. 2 (2018),
1 June 2018
,
Page 63-67
Abstract
This study was performed to assess the short-term effect of sutureless scleral tunnel trabeculectomy procedure with and without topical bevacizumab. Thirty patients with Primary Open-Angle Glaucoma (POAG) were enrolled and randomly divided to two groups. Patients in the first group (15 patients) underwent sutureless trabeculectomy without topical bevacizumab and patients in the second group (15 patients) underwent sutureless trabeculectomy with 1.25 mg of topical bevacizumab. Intraocular Pressure (IOP) of both groups was measured by an expert ophthalmologist, without awareness of the patient’s study group before the operation and six months post-operatively. Out of 30 patients in this study, six females (40%) and nine males (60%) underwent the sutureless trabeculectomy procedure (group A) as well as seven females (46.7%) and eight males (53.3%) underwent sutureless trabeculectomy with topical bevacizumab (group B). The mean age of the patients was not significantly different between the two groups (P = 0.91). A statistically significant difference in time variation of IOP was found between the two groups (P < 0.001). Mean IOP was 18.4 ± 4.35 mmHg in the sutureless group without bevacizumab and 11.73 ± 2.12 mmHg in the sutureless group with bevacizumab, six months post-surgically. No statistical significant differences were found in the baseline IOP between the two groups (P = 0.28). However, IOP changed significantly in group A and B from baseline to six months post-operatively (P = 0.004 and P < 0.001 respectively). According to the current findings, the sutureless trabeculectomy procedure is an effective surgical method for reduction of IOP. Addition of a single dose of 1.25 mg topical bevacizumab was more effective in reduction of IOP compared to sutureless trabeculectomy alone.ÂReferences
Jea SY, Francis BA, Vakili G, Filippopoulos T, Rhee DJ. Ab interno trabeculectomy versus trabeculectomy for open-angle glaucoma. Ophthalmology. 2012;119(1):36-42. doi: 10.1016/j.ophtha.2011.06.04 6 pmid: 21982416
Jampel HD, Musch DC, Gillespie BW, Lichter PR, Wright MM, Guire KE, et al. Perioperative complications of trabeculectomy in the collaborative initial glaucoma treatment study (CIGTS). Am J Ophthalmol. 2005;140(1):16-22. doi: 10.1016/j.ajo.2005.02.013 pmid: 15939389
Ramulu PY, Corcoran KJ, Corcoran SL, Robin AL. Utilization of various glaucoma surgeries and procedures in Medicare beneficiaries from 1995 to 2004. Ophthalmology. 2007;114(12):2265-70. doi: 10.1016/j.ophtha.2007.02.005 pmid: 17466376
Spaeth G. Ophthalmic Surgery: Principles and Practice. 3rd ed. Philadelphia, PA: WB Saunders Co; 2003.
Eslami Y, Mohammadi M, Khodaparast M, Rahmanikhah E, Zarei R, Moghimi S, et al. Sutureless tunnel trabeculectomy without peripheral iridectomy: a new modification of the conventional trabeculectomy. Int Ophthalmol. 2012;32(5):449-54. doi: 10.1007/s10792-012-9607-4 pmid: 22805881
Arish M, Khallaghi H, Soltani E, Akbarpour R. A comparative study of sutureless scleral tunnel trabeculectomy versus conventional trabeculectomy in the management of primary open-angle glaucoma. Int Ophthalmol. 2014;34(5):1055-9. doi: 10.1007/s10792-014-9908-x pmid: 24488091
Lai JS, Lam DS. Trabeculectomy using a sutureless scleral tunnel technique: a preliminary study. J Glaucoma. 1999;8(3):188-92. pmid: 10376259
Suh W, Kee C. The effect of bevacizumab on the outcome of trabeculectomy with 5-Fluorouracil. J Ocul Pharmacol Ther. 2013;29(7):646-51. doi: 10.1089/jop. 2012.0250 pmid: 23621628
Wong MH, Husain R, Ang BC, Gazzard G, Foster PJ, Htoon HM, et al. The Singapore 5-fluorouracil trial: intraocular pressure outcomes at 8 years. Ophthalmology. 2013;120(6):1127-34. doi: 10.1016/ j.ophtha.2012.12.004 pmid: 23466269
Law SK, Shih K, Tran DH, Coleman AL, Caprioli J. Long-term outcomes of repeat vs initial trabeculectomy in open-angle glaucoma. Am J Ophthalmol. 2009;148(5):685-95 e1. doi: 10.1016/j.ajo.2009.05.0 32 pmid: 19596220
Fontana H, Nouri-Mahdavi K, Lumba J, Ralli M, Caprioli J. Trabeculectomy with mitomycin C: outcomes and risk factors for failure in phakic open-angle glaucoma. Ophthalmology. 2006;113(6):930-6. doi: 10.1016/j. ophtha.2006.01.062 pmid: 16647135
Leung DY, Tham CC. Management of bleb complications after trabeculectomy. Semin Ophthalmol. 2013;28(3):144-56. doi: 10.3109/088205 38.2013.771199 pmid: 23697617
Matlach J, Panidou E, Grehn F, Klink T. Large-area versus small-area application of mitomycin C during trabeculectomy. Eur J Ophthalmol. 2013;23(5):670-7. doi: 10.5301/ejo.5000287 pmid: 23640510
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. doi: 10.1016/j.ophtha.2008. 06.009 pmid: 18692246
Choi JY, Choi J, Kim YD. Subconjunctival bevacizumab as an adjunct to trabeculectomy in eyes with refractory glaucoma: a case series. Korean J Ophthalmol. 2010;24(1):47-52. doi: 10.3341/kjo.2010 .24.1.47 pmid: 20157415
Li J, Zhang YP, Kirsner RS. Angiogenesis in wound repair: angiogenic growth factors and the extracellular matrix. Microsc Res Tech. 2003;60(1):107-14. doi: 10.1002/jemt.10249 pmid: 12500267
Nissen NN, Polverini PJ, Koch AE, Volin MV, Gamelli RL, DiPietro LA. Vascular endothelial growth factor mediates angiogenic activity during the proliferative phase of wound healing. Am J Pathol. 1998;152(6):1445-52. pmid: 9626049
O'Neill EC, Qin Q, Van Bergen NJ, Connell PP, Vasudevan S, Coote MA, et al. Antifibrotic activity of bevacizumab on human Tenon's fibroblasts in vitro. Invest Ophthalmol Vis Sci. 2010;51(12):6524-32. doi: 10.1167/iovs.10-5669 pmid: 20574016
Wilgus TA, Ferreira AM, Oberyszyn TM, Bergdall VK, Dipietro LA. Regulation of scar formation by vascular endothelial growth factor. Lab Invest. 2008;88(6):579-90. doi: 10.1038/labinvest.2008.36 pmid: 18427552
Wong J, Wang N, Miller JW, Schuman JS. Modulation of human fibroblast activity by selected angiogenesis inhibitors. Exp Eye Res. 1994;58(4):439-51. doi: 10.1006/exer.1994.1037 pmid: 7523160
Li Z, Van Bergen T, Van de Veire S, Van de Vel I, Moreau H, Dewerchin M, et al. Inhibition of vascular endothelial growth factor reduces scar formation after glaucoma filtration surgery. Invest Ophthalmol Vis Sci. 2009;50(11):5217-25. doi: 10.1167/iovs.08-2662 pmid: 19474408
Cheng G, Xiang H, Yang G, Ma J, Zhao J. Direct Effects of Bevacizumab on Rat Conjunctival Fibroblast. Cell Biochem Biophys. 2015;73(1):45-50. doi: 10.1007/s12013-015-0565-0 pmid: 25656769
Sedghipour MR, Mostafaei A, Taghavi Y. Low-dose subconjunctival bevacizumab to augment trabeculectomy for glaucoma. Clin Ophthalmol. 2011;5:797-800. doi: 10.2147/OPTH.S17896 pmid: 21750613
Fakhraie G, Ghadimi H, Eslami Y, Zarei R, Mohammadi M, Vahedian Z, et al. Short-term Results of Trabeculectomy Using Adjunctive Intracameral Bevacizumab: A Randomized Controlled Trial. J Glaucoma. 2016;25(3):e182-8. doi: 10.1097/IJG.000 0000000000202 pmid: 25493621
Klos-Rola J, Tulidowicz-Bielak M, Zarnowski T. Effects of topical bevacizumab application on early bleb failure after trabeculectomy: observational case series. Clin Ophthalmol. 2013;7:1929-35. doi: 10.2147/OPTH.S45210 pmid: 24109173
Kahook MY. Bleb morphology and vascularity after trabeculectomy with intravitreal ranibizumab: a pilot study. Am J Ophthalmol. 2010;150(3):399-403 e1. doi: 10.1016/j.ajo.2010.03.025 pmid: 20570237
Kaushik J, Parihar JK, Jain VK, Gupta S, Nath P, Durgapal P, et al. Efficacy of Bevacizumab Compared to Mitomycin C Modulated Trabeculectomy in Primary Open Angle Glaucoma: A One-Year Prospective Randomized Controlled Study. Curr Eye Res. 2017;42(2):217-24. doi: 10.3109/02713683.2016.116 4188 pmid: 27269279
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