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Long-term effects of intraoperative topical bevacizumab in sutureless scleral tunnel trabeculectomy: a prospective clinical trial

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Abstract

Purpose

To investigate the long-term efficacy and safety of the novel method sutureless trabeculectomy with topical administration of bevacizumab.

Materials/Methods

Primary open-angle glaucoma patients with intraocular pressure (IOP) > 21 mmHg despite maximum tolerated medication were included in a single-blind prospective interventional clinical trial. Group 1 underwent sutureless scleral tunnel trabeculectomy with intraoperative topical administration of bevacizumab (1.25 mg) applied on the scleral incision for 1 min. Group 2 underwent sutureless trabeculectomy alone and group 3 (control group) underwent conventional trabeculectomy with mitomycin C (MMC). Outcome measures were surgical success, IOP, number of needed anti-glaucoma medications, and complications. Patients were followed for two years.

Results

Finally, 50 eyes from group 1, 46 from group 2, and 47 from group 3 were analyzed. At the end of 24 months, 52% (n = 26) of group 1, 34.8% (n = 16) of group 2, and 57.4% (n = 27) of group 3 had complete success (IOP < 18 mmHg without medication). The difference was only significant between groups 2 and 3 (p = 0.003). 94% (n = 47) of group 1, 89.1% (n = 41) of group 2, and 91.5% (n = 43) of group 3 had qualified success (IOP < 18 mmHg with ≤ 2 anti-glaucoma medications) (p = 0.69). There was a significant difference in the overall IOP mean between the three groups (p < 0.0001). There was no significant difference between the three groups in complication rates and the number of needed anti-glaucoma medications for IOP control.

Conclusion

Sutureless trabeculectomy with topical application of bevacizumab showed comparable surgical success rates with conventional trabeculectomy and MMC in long-term follow-up. Additionally, adjuvant use of topical bevacizumab had a significant positive impact on long-term IOP control.

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Acknowledgements

Authors would like to thank Dr. Farzad Mohammadi, Professor of Ophthalmology in Farabi Eye Hospital, affiliated with Tehran University of Medical Sciences and Health Services, for his advice and contributions.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Alzahra Eye Hospital Research Center, Zahedan University of Medical Sciences, Zahedan, Iran

    Mohammad Arish, Meisam Sargazi, Shima Dehghani & Mahya Sahami

  2. Department of Nutrition, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran

    Alireza Dashipour

  3. Department of Community Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran

    Saeedeh Sarhadi

  4. Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Hamidreza Rouientan

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Contributions

M.A. and M.S provide study design, methodology, project administration; S.S. and A.D performed visualization, formal analysis, data collection, interpretation of data; S.D. and MA.SA and H.R did data collection, writing original draft. All authors reviewed the manuscript.

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Correspondence to Meisam Sargazi.

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Arish, M., Sargazi, M., Dehghani, S. et al. Long-term effects of intraoperative topical bevacizumab in sutureless scleral tunnel trabeculectomy: a prospective clinical trial. Int Ophthalmol 43, 4225–4233 (2023). https://doi.org/10.1007/s10792-023-02833-9

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