To compare the outcome of trabeculectomy using adjunctive intracameral bevacizumab versus intraoperative mitomycin C (MMC) application

In this prospective, double-blind, randomized clinical trial 87 eyes of 87 patients with primary open-angle or pseudoexfoliation glaucoma were randomly assigned to each treatment group (44 cases received 1.25 mg intracameral bevacizumab at the end of operation and in 43 cases MMC was applied under the conjunctiva and scleral flap). Success was defined as intraocular pressure (IOP) between 6 and 21 mmHg and at least 30% IOP drop at the last postoperative visit with (qualified) or without (complete) glaucoma medications without requiring additional glaucoma surgery.

The mean follow up time was 17.12 ± 2.58 months in the bevacizumab group and 17.23 ± 2.42 months in the MMC group (P =0.845). The mean preoperative IOP was 29.17 ± 3.94 mm Hg and 28.8 ±4.08 mm Hg in the bevacizumab and MMC groups, respectively (P = 0.689). This value at last visit was 17.41 ± 3.11 mmHg in the bevacizumab group and 15.34 ± 3.62 mmHg in the MMC group (P<0.009). Compared with baseline, IOP drop at last visit was 11.76 ± 5.51 and 13.43 ± 5.92 in the bevacizumab and MMC groups, respectively (P= 0.207). At last visit, complete success was achieved in 25 cases (61%) of bevacizumab group and 23 cases (66%) of MMC group (P=0.669). Early filtering bleb leak was more prevalent in bevacizumab group (29% vs 11%).

A single 1.25 mg dose of intracameral bevacizumab improves the success of trabeculectomy comparable to MMC; however, it increases the risk of early filtering bleb leakage.