Clinical evaluation of the effect of topical bevacizumab on morphology and function of filtering bleb with failure symptoms Original reaserch study

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Anna Kuna
Tomasz Żarnowski


Objectives: Evaluation of bevacizumab drops in patients undergoing trabeculectomy in order to inhibit postoperative wound healing.
Material and methods: A total of 53 patients treated surgically for glaucoma. The anti-glaucoma procedures with the creation of a filtering bleb were performed. The patients developed early postoperative bleb insufficiency qualifying them for the use of bevacizumab drops. Thirty were completely statistically analyzed; intraocular pressure and slit lamp examinations were performed and the bleb was assessed according to the MBGS. Additionally, photographs of the filtering blebs were made, which were used for bleb morphological analysis.
Results: Total success, after 6 months, without using anti-glaucoma drugs (intraocular pressure < 18 mmHg and a decrease in baseline intraocular pressure by 30%) was observed in 18 patients (60%). Partial success, after 6 months, without using anti-glaucoma drugs (decrease in baseline intraocular pressure by 30%) was achieved in 19 patients (63.3%).
Conclusions: Bevacizumab is an effective and safe adjunctive therapy with topical steroids for the treatment of early postoperative filtering bleb insufficiency as it reduces innervation on the bleb surface. Evaluation of the mean surface of bleb vessels on photographs, using ImageJ (Wayne Rasband), correlates with MBGS evaluation of filtering blebs.

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Kuna A, Żarnowski T. Clinical evaluation of the effect of topical bevacizumab on morphology and function of filtering bleb with failure symptoms. Ophthatherapy [Internet]. 2020Sep.30 [cited 2020Nov.30];7(3):203-12. Available from:
Conservative treatment


1. Cairns JE. Trabeculectomy. Preliminary report of a new method. Am J Ophthalmol. 1968; 66: 673-8.
2. Ferrara N. Role of vascular endothelial growth factor in regulation of angiogenesis. Kidney Int. 1999; 56: 794-814.
3. Senger DR, Galli SJ, Dvorak AM et al. Tumor cells secrete a vascular permeability factor that promotes accumulation of ascites fluid. Science (Wash DC). 1983; 219: 983-5.
4. Hurwitz H, Fehrenbacher L, Novotny W et al. Bevacizumab plus irinotecan, fluorouracil, and leukovorin for metastatic colorectal cancer. New Engl. J. Med. 2004; 350: 2335-42.
5. Kitazawa Y, Kawase K, Matsushita H et al. Trabeculectomy with mitomycin. A comparative study with fluorouracil. Arch Ophthalmol. 1991; 109(12): 1693-8.
6. Jurkowska-Dudzińska J, Kosior-Jarecka E, Żarnowski T. Comparison of the use of 5-FU and bevacizumab in primary trabeculectomy: results at one year. Clin Exp Ophthalmol. 2012; 40: 135-42.
7. Kłos-Rola J, Tulidowicz-Bielak M, Żarnowski T. Effects of topical bevacizumab application on early bleb failure after trabeculectomy: observational case series. Clin Ophthalmol. 2013; 7: 1929-35.
8. Kronfeld PC. The mechanism of filtering operations. Trans Pac Coast Otoophthalmol Soc Annu Meet. 1949; 33: 23-40.
9. Van Buskirk EM. Cysts of Tenon’s capsule following filtration surgery. Am J Ophthalmol. 1982; 94: 522-7.
10. Pavlin CJ, Harasiewicz K, Foster FS. Ultrasound biomicroscopy of anterior segment structures in normal and glaucomatous eyes. Am J Ophthalmol. 1992; 113(4): 381-9.
11. Savini G, Zanini M, Barboni P. Filtering blebs imaging by optical coherence tomography. Clin Exp Ophthalmol. 2005; 33: 483-9.
12. Leung CK, Yick DW, Kwong YY et al. Analysis of bleb morphology after trabeculectomy with Visante anterior segment optical coherence tomography. Br J Ophthalmol. 2007; 91(3): 340-4.
13. Crowston JG, Kirwan JF, Wells AP et al. Evaluating clinical signs in trabeculectomized eyes. Eye. 2004; 18: 299-303.
14. Crowston JG, Wells AP, Kirwan J et al. Distant evaluation of postoperative trabeculectomy cases. Clin Experiment Ophthalmol. 2000; suppl: 134.
15. Wells AP, Crowston JG, Marks J et al. A pilot study of a system for grading of drainage blebs after glaucoma surgery. J Glaucoma. 2004; 13(6): 454-60.
16. Akkan JU, Cilsim S. Role of subconjunctival bevacizumab as an adjuvant to primary trabeculectomy: a prospective randomized comparative 1-year follow-up study. J Glaucoma. 2015; 24(1): 1-8.
17. Nilforushan N, Yadgari M, Kish SK et al. Subconjunctival bevacizumab versus mitomycin C adjunctive to trabeculectomy. Am J Ophthalmol. 2012; 153(2): 352-7.
18. Ichhpujani P, Ramasubramanian A, Kaushik S et al. Bevacizumab in glaucoma: a review. Can J Ophthalmol. 2007; 42: 812-515.
19. Miki A, Ochima Y, Otori Y et al. Efficacy of intravitreal bevacizumab as adjunctive treatment with pars plana vitrectomy, endolaser photocoagulation, and trabeculectomy for neovascular glaucoma. Br J Ophthalmol. 2008; 92: 1431-3.
20. Grewal DS, Jain R, Kumar H et al. Evaluation of subconjunctival bevacizumab as an adjunct to trabeculectomy: a pilot study. Ophthalmology. 2008; 115: 2141-5.
21. Spaeth GL. Chirurgia okulistyczna. Elsevier Urban & Partner, Wrocław 2006.
22. Fuller JR, Bevin TH, Molteno ACB et al. Anti-inflammatory fibrosis suppression in threatened trabeculectomy bleb failure produces good long term control of intraocular pressure without risk of sight threatening complications. Br J Ophthalmol. 2002; 86(12): 1352-4.
23. Arosemena A, Ayyala RS. Steps for saving failing blebs after trabeculectomy. Needling can be successful in early and late cases of bleb revision. Ocular Surgery News. U.S. Edition, February 1, 2004.
24. Fechner PU, Wichman W. Retarded corneo-scleral wound healing associated with high preoperative doses of systemic steroids in glaucoma surgery. Refract Corneal Surg. 1991; 7: 174-6.
25. Roth SM, Spaeth GL, Starita RJ et al. The effects of postoperative corticosteroids on trabeculectomy and the clinical course of glaucoma: Five year follow-up study. Ophthalmic Surg. 1991; 22: 724-9.
26. Żarnowski T, Tulidowicz-Bielak M. Topical bevacizumab is efficacious in the early bleb failure after trabeculectomy. Acta Ophthalmol. 2011; 89: 605-6.