Adjunctive Bevacizumab in Patients Undergoing Ahmed Valve Implantation: A Pilot Study

Abstract

Background and Objective: To report on preliminary findings of adjunctive subconjunctival bevacizumab (SCB) injections in patients undergoing Ahmed valve implantation (AVI) (New World Medical, Rancho Cucamonga, CA). Patients and Methods: The study was approved by the institution’s ethics committee. Patients were prospectively recruited during a 1-month period and randomized to receive AVI with postoperative SCB (days 1 and 7, n = 7) or AVI without SCB (n = 6). Results: Baseline intraocular pressure (IOP) in the treatment (AVI+SCB) group was 19.4 ± 8.6 mm Hg, whereas baseline IOP in the control (AVI) group was 32.1 ± 17.7 mm Hg ( P = .119). Final IOP was 13.8 mm Hg (n = 7) for the treatment group and 12.7 mm Hg for the control group (n = 5, P = .790). One eye in the control group required further glaucoma intervention at day 45 and was considered a failure. The pre-massage postoperative IOP was significantly lower for the treatment group only at day 45 (16.1 vs 26.0 mm Hg, P = .012). Mean post-massage IOP was significantly lower in the treatment group at day 15 (11.28 vs 17.16 mm Hg, P = .004), day 30 (11.28 vs 20.83 mm Hg, P = .015), and day 45 (12.16 vs 21.33 mm Hg, P = .001), and similar at month 3. Mean change in bleb area was 11.4 mm 2 in the treatment group and −0.4 mm 2 in the control group ( P = .036 and P = .361, respectively, Student’s paired samples t test). Conclusion: Bevacizumab was associated with a less aggressive hypertensive period as measured by post-massage IOP measurements, postoperative glaucoma medications, and cross-sectional bleb area by ultrasound. Further prospective studies are needed to better understand the utility of SCB at the time of AVI surgery.

Does Bevacizumab Improve Outcomes After Ahmed Glaucoma Valve Implantation for Refractory Glaucoma?: A Meta-Analysis

“…The inclusion and exclusion criteria were applied to the full texts of the remaining 38 studies after which a total of 5 RCTs were included in this metaanalysis. [25][26][27][28][29] Notably, preliminary searches did not identify any suitable RCTs for inclusion of non-valved implants.…”

“…The 3 remaining studies administered subconjunctival bevacizumab (SCB) at the end of the operation or day 1 after the operation in patients with all types of refractory glaucoma. 25,28,29 The Cochrane Risk of Bias 2.0 tool was applied to assess the included RCTs for methodological soundness by 2 authors (L.T. and J.V.).…”

“…18 As depicted in Figure 2, all 5 studies had some concerns. [25][26][27][28][29] The number of included studies (n = 5) was inadequate for the application of funnel plot assessment or regression-based techniques in the detection of publication bias. 20,21 Mean Intraocular Pressure All 5 RCTs [25][26][27][28][29] reported mean IOP at 1 month and 3 months, whereas 4 studies [26][27][28][29] reported mean IOP at 6 months, 12 months, and beyond.…”

“…[25][26][27][28][29] The number of included studies (n = 5) was inadequate for the application of funnel plot assessment or regression-based techniques in the detection of publication bias. 20,21 Mean Intraocular Pressure All 5 RCTs [25][26][27][28][29] reported mean IOP at 1 month and 3 months, whereas 4 studies [26][27][28][29] reported mean IOP at 6 months, 12 months, and beyond. There was a tendency for the bevacizumab group to have lower mean IOP at all common follow-up points with mean IOP difference between groups ranging from −2.74 mm Hg (−6.45 to 0.97) at 1 month to −3.74 mm Hg (−10.17 to 2.68) at 6 months.…”

“…Arcieri et al (2015) 26 and Miraftabi et al (2018) 28 reported the mean IOP-lowering medications at all time points of interest. Meanwhile, the corresponding author of Rojo-Arnao et al (2011) 25 unsuccessful. 27,29 No statistical difference in mean IOPlowering medications was observed between groups at any timepoint of interest (Fig.…”