Trabeculectomy with mitomycin C alone or with mitomycin C plus intracameral bevacizumab—A comparative study

PurposeTo compare the long‐term outcomes of trabeculectomy using mitomycin C (MMC) alone versus MMC plus intracameral bevacizumab.MethodsRetrospective, comparative study (#ISRCTN93098069). Patients’ charts from two centers were reviewed for data between October 2015 and March 2019. Minimum follow‐up of 12 months was required. The main efficacy outcome was intraocular pressure (IOP) lowering at 12 and 24 months, with surgical success defined as IOP ≤18 mmHg and >5 mmHg with at least 30% reduction from baseline. Absolute success was achieved if no IOP‐lowering medication was needed and a qualified success considered otherwise. Safety outcomes were also analyzed.ResultsA total of 111eyes underwent trabeculectomy with MMC, 52 of them combined with intracameral bevacizumab. 78% were followed for at least two years. Baseline IOP was 24.5 ± 8.9 mmHg and 23.8 ± 8.3 mmHg for the MMC and the MMC+bevacizumab groups, respectively (p = 0.97). During the early post‐operative period (at 3 months), mean IOP was lower in the MMC+bevacizumab group (9.3 ± 2.3 mmHg versus 11.1 ± 5.5 mmHg, p = 0.03). At 24‐month visit, IOP was significantly reduced (MMC group: 10.6 ± 3.4 mmHg; MMC+bevacizumab group: 10.9 ± 4.1 mmHg, p < 0.01) with no difference between groups (p = 0.61). Absolute success was higher in the MMC+bevacizumab group at 12 months (86% versus 75%, p = 0.16) and at 24 months (83% versus 67%, p = 0.14), with the need for IOP‐lowering re‐interventions (needlings) being lower in this group (2% versus 17%, p = 0.01). Almost all patients (98%) of the MMC+bevacizumab group were drop‐free at 12 months and nearly half (44%) had an IOP in the single‐digit range (≤ 9 mmHg) at 24 months. Complication rates were low and similar between groups, with no systemic adverse events.ConclusionsAdding perioperative intracameral bevacizumab to the standard of care use of MMC in trabeculectomy seems to allow for sustained low IOP outcomes. Furthermore, it seems to decrease the need for additional interventions during the early post‐operative period.