Efficacy of Two Drugs in Trabeculectomy: A Quasi Experimental Study

Qirat Qurban, Zeeshan Kamil, Khalid Mahmood

Abstract

Objective

To find the additive effect of bevacizumab on outcome of trabeculectomy surgery augmented with mitomycin C in patients with primary open angle glaucoma on maximum topical anti glaucoma drug therapy.

Study design

Quasi experimental study.

Place & Duration of study

Department of Opthalmology, Khalid Eye Clinic Karachi, from July 2018 to June 2019.

Methodology

This study recruited 56 patients between the ages of 25 year to 50 year of both gender, divided into two groups of 28 patients each. Patients with primary open angle glaucoma with intraocular pressure (IOP) of more than 26 mmHg on maximum topical drug therapy were included. Patients of both the groups underwent traditional trabeculectomy surgery with peroperative application of mitomycin C over the scleral flap region. Patients of group A received sub conjunctival injection of bevacizumab whereas group B patients received placebo containing normal saline sub-conjunctival injection at the end of the surgery. Main outcome measures were control of intraocular pressure at the end of one year, reduction in use of topical drug therapy and vascularization of bleb. All the patients were followed up for one year. Paired t test and Chi square test were applied for statistical analysis.

Results

Mean preoperative intraocular pressure in group A was 28.6±1.33 mmHg whereas in group B 28.4±1.31 mmHg (p=0.607). Mean postoperative intraocular pressure in group A was 13.0±1.29mmHg whereas in group B 17.4±1.4 mmHg. In group A 24 (85%) patients did not require any anti-glaucoma topical therapy postoperatively, and 24 (15%) patients required single drug therapy. In group B, 18 (64%) patients did not need any topical anti-glaucoma drug whereas 10 (36%) patients required single drug therapy (p= 0.061). Mild vascularization of the bleb was observed in one (0.03%) patient of group A and seven (25%) of group B (p=0.026).

Conclusion•

Augmented trabeculectomy surgery with mitomycin C is effective in controlling the intraocular pressure but the adjuvant use of bevacizumab had an additional effect on the outcome of trabeculectomy surgery.

Key words

Bevacizumab, Mitomycin C, Primary open angle glaucoma, Trabeculectomy.