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Year : 2018  |  Volume : 2  |  Issue : 2  |  Page : 123-128

Subconjunctival bevacizumab versus mitomycin c as adjuvant treatment to subscleral trabeculectomy

Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Correspondence Address:
Mohamed I El-Kasaby
Assist prof of Ophthalmology Cairo, Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, 93 AL-Mahdy Bin Baraka Street Nasr City Seventh Avenue Postal-Code 11816
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjamf.sjamf_18_18

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Aim To compare the clinical outcome of adjuvant subconjunctival bevacizumab (BVZ) injection versus mitomycin C (MMC) during subscleral trabeculectomy. Patients and methods In this study, 20 patients who were divided into two groups: group A included 10 (20 eyes) patients who underwent subscleral trabeculectomy with subconjunctival injection of 1.25 mg/0.1 ml BVZ, and group B included 10 (20 eyes) patients who underwent subscleral trabeculectomy with adjuvant intraoperative use of 0.2 mg/ml MMC for 2 min. This prospective nonrandomized clinical comparative study was conducted in Nour-El-Hayaha Eye Center (Cairo). Patients were diagnosed for primary open angle glaucoma with uncontrolled intraocular tension by maximum tolerable antiglaucoma therapy. The study excluded patients with neovascular glaucoma, congenital and juvenile glaucoma, history of ocular pathology, or surgery as retinal surgeries and uveitis. Results Twenty patients were considered for the study, nine (45%) patients (18 eyes) were males and 11 (55%) patients (22 eyes) were females. The patients’ ages ranged from 35 to 65 years (mean age 55.2±8.3). Mild hyphema, in one eye in group A (8.33%), wound leak in one (8.33%) eye in each group, and shallow anterior chamber in two (16.7%) cases in each group. It was the most common encountered complication in our study. One (8.33%) case of shallow anterior chamber in group A led to choroidal effusion. One (8.33%) case in group B developed late bleb-related endophthalmitis after 3 months, which ended in phthisis bulbi. Conclusion The success of glaucoma filtration surgery is heralded by a wound healing response mainly mediated by fibroblast proliferation, migration, and contraction that leads to postoperative subconjunctival scar. The effect of subconjunctival BVZ and MMC-augmented trabeculectomy in cases of primary open angle glaucoma was beneficial in improving the success rate with better intraocular pressure control and prolonging the trabeculectomy survival with no significant difference between the two groups.

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