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Trabeculectomy with mitomycin C alone or coupled with intracamerular bevacizumab? A 2-year comparative study
  1. Patrícia José1,2,
  2. Filipa Jorge Teixeira1,2,
  3. Rafael Barão1,2,
  4. David Cordeiro Sousa1,2,3,4,
  5. Raquel Esteves Marques1,2,
  6. Andre Diogo De Oliveira Barata1,2,5,
  7. Carlos Marques-Neves1,2,3,
  8. Marta Alves6,
  9. Ana Luísa Papoila6,
  10. Ingeborg Stalmans7,
  11. José Pedro Silva5,
  12. Luis Abegão Pinto1,2,3,5
  1. 1 Ophthalmology, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
  2. 2 Ophthalmology University Clinic, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
  3. 3 Vision Sciences Study Center, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
  4. 4 Vitreoretinal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
  5. 5 Ophthalmology, Hospital Lusíadas Lisboa, Lisboa, Portugal
  6. 6 CEAUL, Biostatistics Department, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
  7. 7 KU Leuven University Hospitals Leuven, Leuven, Belgium
  1. Correspondence to Dr Patrícia José, Ophthalmology, Hospital de Santa Maria, Lisboa 1649-035, Portugal; patricialopes1{at}


Purpose To compare outcomes of primary trabeculectomy using either mitomycin C (MMC) alone versus MMC augmented with intracamerular bevacizumab in patients with open-angle glaucoma.

Methods Retrospective, cohort, two-centre, comparative study. Patients’ data were screened between October 2015 and March 2019, with inclusion requiring a minimum follow-up of 24 months. Primary outcome was intraocular pressure (IOP) lowering at 24 months, with surgical success defined with different maximum IOP targets (≤18, ≤16 and ≤14 mm Hg) and at least 30% reduction and higher than 5 mm Hg. Absolute success was achieved if no IOP-lowering medication was needed and a qualified success if otherwise. Safety outcomes were analysed.

Results A total of 110 eyes underwent trabeculectomy with MMC, 51 of these combined with intracamerular bevacizumab. Both strategies were effective in terms of IOP lowering (baseline vs 2 years postoperatively: 24.4 (8.0) mm Hg vs 12.1 (5.3) mm Hg in the MMC group; 25.1 (8.7) vs 10.8 (3.8) mm Hg in the MMC+bevacizumab group; p<0.001 in both comparisons). The MMC+bevacizumab group had a significant difference towards higher efficacy on absolute success rates at all targets (IOP≤14 or ≤16 or ≤18 mm Hg; p=0.010, p=0.039 and p=0.007, respectively). The large majority (93%) of the MMC+bevacizumab group was drop-free at 24 months, and 41% had IOP below 10 mm Hg. Complication rates were low and similar between groups, with no systemic adverse events.

Conclusions Intracamerular bevacizumab in MMC-augmented primary trabeculectomy increases the chances of obtaining low IOP outcomes. This strategy may be useful when planning for surgeries aiming at target pressures in the low teens.

Trial registration number ISRCTN93098069.

  • glaucoma
  • aqueous humour
  • optic nerve
  • treatment surgery

Data availability statement

Data are available in a public, open access repository.

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Data availability statement

Data are available in a public, open access repository.

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  • Contributors Conception and design of the work: PJ, JPS and LAP. Acquisiton, analysis and interpretation of data: PJ, FJT, RB, DCS, REM, MA, ALP and LAP. Revision of the work: PJ, DCS, REM, ADDOB, CM-N, MA, ALP, IS and LAP. Final approval of the version to be published: PJ, FJT, RB, DCS, REM, ADDOB, CM-N, MA, ALP, IS, JPS and LAP.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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