Evaluation the adjunctive use of combined bevacizumab and mitomycinc to trabeculectomy in management of recurrent pediatric glaucoma

• Published in: Eye (London) 2016-01, Vol.30 (1), p.53-58
• Main Authors: Mahdy, R A, Al-Mosallamy, S M, Al-Aswad, M A, Bor'i, A, El-Haig, W M
• Format: Article
• Language: English
• Subjects: 692/1807; 692/699/3161; Alkylating Agents - administration & dosage; Angiogenesis Inhibitors - therapeutic use; Bevacizumab - therapeutic use; Child, Preschool; Clinical Study; Drug Therapy, Combination; Follow-Up Studies; Glaucoma; Humans; Hydrophthalmos - drug therapy; Hydrophthalmos - physiopathology; Hydrophthalmos - surgery; Hydrophthalmos - therapy; Infant; Injections, Intraocular; Intraocular Pressure - physiology; Laboratory Medicine; Medicine; Medicine & Public Health; Mitomycin - administration & dosage; Ophthalmology; Pharmaceutical Sciences/Technology; Prospective Studies; Recurrence; Surgery; Surgical Oncology; Trabeculectomy; Treatment Outcome; Vascular Endothelial Growth Factor A - antagonists & inhibitors
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/eye.2015.182

Purpose To evaluate the efficacy and safety of combined bevacizumab–mitomycin c (MMC) in recurrent cases of pediatric glaucoma. Methods A prospective non-masked controlled study that included bilateral cases of 12 patients (24 eyes) with recurrent (had previous glaucoma surgery before) pediatric glaucoma. One eye in each patient (12 eyes) was assigned to trabeculectomy operation with combined application of MMC (0.4 mg/ml for 3 min) under and around the scleral flap before trabeculectomy and bevacizumab (avastin) (2.5 mg in 0.2 ml) injected subconjunctivally around the bleb after completing the surgery (group I). The other eye of each patient (12 eyes) was assigned to trabeculectomy operation with application of MMC (0.4 mg/ml for 3 min) only (group II). The mean follow-up period was 13±1 months. Results The mean age was 2.16±1.5 (range 7 months to 4.1 years). No significant difference in preoperative intraoperative pressure (IOP) was observed between the groups ( P >0.05). Recurrent primary congenital glaucoma represents 66.7% of the cases. Other cases included were recurrent aphakic and pseudophakic glaucoma 25% and recurrent post uveitic glaucoma 8.3%. The mean IOP was 12.1±4.2, 12.6±5.4, and 12.8±5.2 mm Hg in group I at 3, 6, and 12 months, respectively, and was 12.8±5.3, 13.7±6.7 and 15.6±5.9 mm Hg in group II at 3, 6, and 12 months, respectively. There was a statistically significant difference in the mean IOP between the studied groups at the 1-year follow-up visit ( P