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

Abstract

Prècis: Mean IOP, complete and overall success, mean IOP-lowering medications, incidence of hypertensive phase and complications were found to be comparable between patients undergoing Ahmed Glaucoma Valve implantation (AGVI) with adjunctive bevacizumab versus AGVI alone. Purpose: This meta-analysis aims to assess how adjunctive bevacizumab impacts the surgical outcomes of Ahmed glaucoma valve implantation (AGVI) compared to AGVI alone in all subtypes of refractory glaucoma. Methods: A systematic search of databases for relevant randomised controlled trials (RCTs) was performed in March 2023. Primary outcomes included mean intraocular pressure (IOP) and success rates. Secondary outcomes were mean IOP-lowering medications, incidence of hypertensive phase, and complications. Qualitative assessment, meta-analysis, subgroup analyses, and sensitivity analysis were performed. Results: Five RCTs comprising 203 eyes were included in the quantitative analysis. Initial meta-analysis showed a strong yet non-significant trend (all P>0.05) favouring adjunctive bevacizumab in all outcomes of interest. Significant heterogeneity was observed for mean IOP and success outcomes at all timepoints (all I2>50%). Subgroup analysis of administration route revealed a reduced incidence of hyphaema in the intravitreal bevacizumab (IVB) subgroup (OR, 0.10; 95% CI, 0.02–0.59; P=0.01) with significant heterogeneity persisting in the IVB subgroup for all measures (all I2>50%). Post hoc sensitivity analysis of studies without concurrent PRP for mean IOP and success outcomes demonstrated more conservative effect sizes with a corresponding decrease in heterogeneity for all measures (all I2<30%). Conclusion: Published studies investigating the role of adjunctive bevacizumab show a strong trend to improved outcomes but contain a relatively small number of participants. This analysis underpins the need for an adequately powered RCT to explore the role of anti-VEGF agents in AGVI surgery.