Intravitreal Bevacizumab Improves Trabeculectomy Survival at 3 Years

PURPOSE: To evaluate the effect of a single intraoperative dose of intravitreal bevacizumab (Avastin) on surgical success after trabeculectomy with mitomycin-C (MMC) over 3 years. DESIGN: Single-center, parallel, double-masked, randomized, placebo-controlled trial. The setting was a single ophthalmic outpatient referral center within a tertiary teaching hospital. PARTICIPANTS: Patients requiring primary or redo trabeculectomy or phacotrabeculectomy for progressing glaucoma. Patients were randomized to a single intraoperative intravitreal injection of Avastin (1.25 mg in 0.05 mL) or placebo (balanced salt solution 0.05 mL). MAIN OUTCOME MEASURE: The primary outcome was treatment success, which was defined by "complete success" when intraocular pressure (IOP) remained less than a predefined target IOP without the requirement of topical medication or "qualified success" when topical medication was required to meet the predefined target IOP threshold. RESULTS: From a total of 131 patients randomized to bevacizumab (Avastin; n = 65) or placebo (n = 66), 111 patients completed 36 months of follow-up (85%). At 36 months, trabeculectomy survival was higher in the bevacizumab cohort (hazard ratio [complete success] = 0.17, P = 0.002; [qualified success] = 0.07, P = 0.03). Within the placebo cohort, the requirement for topical therapy was higher at 3 months (P = 0.008), 6 months (P = 0.009), 12 months (P = 0.007), and 36 months (P < 0.005). CONCLUSIONS: Bevacizumab was given as a single intravitreal dose during trabeculectomy with MMC resulting in improved surgical success at 36 months postoperatively.