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Editors Selection IGR 15-2

Surgical Therapy: Antifibrotic effect of bevacizumab

Comment by Malik Kahook on:

27053 Antifibrotic Activity of Bevacizumab on Human Tenon's Fibroblasts In Vitro., O'Neill EC; Qin Q; Van Bergen NJ et al., Investigative Ophthalmology and Visual Science, 2010; 51: 6524-6532

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The use of anti-vascular endothelial growth factor (VEGF) medications for modulation of wound healing after glaucoma surgery could potentially improve post-operative outcomes. O'Neill et al. (2029) investigated the anti-fibrotic effects of bevacizumab, a full-length humanized monoclonal antibody directed against isoforms of VEGF-A, on human Tenon's capsule fibroblasts (HTF) in vitro. They found that bevacizumab induced a significant dose-related reduction of cell number and scanning electron microscopy revealed marked vacuolization in bevacizumab-treated fibroblasts. The study concluded that bevacizumab inhibited a number of fibrosis activities in culture and that these findings may 'underpin the anti-fibrosis effect proposed in vivo.'^1-3 Guarded filtration surgery, commonly referred to as trabeculectomy, remains the gold standard incisional surgery for patients with elevated intraocular pressure despite medical and/or laser therapy. The major cause of failure for this surgical approach is scarring of the fistula at the level of the scleral flap as well as at the level of Tenon's capsule. Currently utilized anti-fibrotic medications such as mitomycin C (MMC) and 5-fluorouracil have increased the success of trabeculectomy, but this has come at the cost of increasing side effects such as leaking blebs and infections. The recognition that alternatives to these agents are present and should be studied can only improve future patient care. It is also imperative to consider combination therapies that address multiple components of the wound healing process. For example, use of low dose MMC along with anti-VEGF agents at time of surgery may decrease subsequent scar formation without increasing bleb leaks or infections. The authors should be commended for their course of study and their findings only bolster the growing in vivo data that indicate anti-VEGF agents may play a role in improving wound modulation after glaucoma filtration surgery.

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