Evaluation of The Efficacy of Aflibercept versus Mitomycin C in Trabeculectomy in Cases of Primary Open Angle Glaucoma

Abstract

Article informationBackground: Post-operative scarring at the bleb site is a major factor in whether or not a trabeculectomy is successful. Mitomycin C and anti-vascular endothelial growth factor drugs like Aflibercept have been frequently used as supplementary treatments to trabeculectomy. Aim of the Study:This study aims to compare the efficacy of aflibercept and mitomycin c in trabeculectomy in patients with primary open-angle glaucoma. Patients and Methods: This prospective interventional study was carried out in Al-Azhar University Hospital in New Damietta from 2021 to 2023 on 40 patients with uncontrollable bilateral primary open angle glaucoma. Patients were divided into 2 groups each patient was represented in each group with one eye: Group 1, Included 20 eyes with medically uncontrolled primary open-angle glaucoma in which sub scleral trabeculectomy with intraoperative mitomycin C [0.3mg/1ml] topical application was done. Group 2, Included 20 eyes with medically uncontrolled primary open-angle glaucoma in which subscleral trabeculectomy with intraoperative subconjunctival single dose of Eylea [2 mg / 0.05 mL] was done. Results: According to the IOP, we found a statistically significant reduction in the IOP from 25 [23-28] mmHg in group 1 and 25 [23-28] mmHg in group 2 at the baseline to 14 [13-15] mmHg in group 1 and 16 [15-16] mmHg in group 2 at 12 months postoperative [P = 0.001]. In terms of the Bleb evaluation, the Mainz score was used for the Bleb assessment all over the follow-up periods. It consists of seven main domains, bleb height, peripheral vascularity, central vascularity, transparency, microcyst formation, and conjunctival mobility. We found no statistically significant difference between the 2 groups as regards all Mainz domains over the follow-up periods [P > 0.05 for all]. Conclusion:The use of intraoperative subconjunctival single-dose Aflibercept in trabeculectomy is safe effective and comparable to the use of MMC in terms of the advantage of avoiding the potentially dangerous complications related to MMC use.