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Editors Selection IGR 18-2

Surgical Therapy: Ahmed implant and Bevacizumab

Comment by Kouros Nouri-Mahdavi on:

47014 Adjunctive bevacizumab in patients undergoing Ahmed valve implantation: A pilot study, Rojo-Arnao M; Albis-Donado OD; Lliteras-Cardin M et al., Ophthalmic Surgery Lasers and Imaging, 2011; 42: 132-137

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Rojo-Arnao et al. (1600) report results of a small randomized study comparing surgical outcomes after placement of Ahmed Glaucoma Valve (AGV) with and without postoperative use of subconjunctival Bevacizumab (SCB). Seven eyes were randomized to receive SCB and six eyes were followed without after surgery. The final IOPs tended to be lower in the SCB group with or without massage at three months although statistical significance was not reached likely due to the small sample size. The hypertensive phase seemed to be less common in the group receiving SCB and mean bleb area was higher in the treatment group at day 90. The authors have addressed an interesting and clinically relevant question, but I don't think the results quite answer the issue addressed since such a small number of eyes were enrolled. The other issue confounding the results is the significantly different preoperative baseline IOPs with the group receiving SCB having a lower IOP (19.4 vs. 32.1 mmHg). Although there are no definitive data regarding the prevalence of hypertensive phase as a function of preoperative IOP, I would speculate that eyes with a lower preoperative IOP probably have a lower chance of developing hypertensive phase since the outflow pathways are still functioning to some degree. Also, half of the eyes in the control group had neovascular glaucoma, which is known to be associated with poorer outcomes after placement of glaucoma drainage devices. Patients were followed only for three months and we can only speculate how different the outcomes would be on longer follow-up. In summary, the authors have presented some encouraging results with SCB injection after AGV implantation. However, the results should be considered preliminary and further research would be necessary before one can make a case for or against using SCB after glaucoma drainage device surgery.

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