Bevacizumab together with MMC may have complementary effects in the improvement of surgical outcome after glaucoma filtration surgery

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Abstract

Purpose

We first compared the effect of mitomycin-C (MMC) versus bevacizumab on the surgical outcome of glaucoma filtration surgery (GFS). Secondly, the complementary effects of MMC and anti-VEGF therapy were investigated.

Methods

The effect of bevacizumab and MMC on surgical outcome was investigated in a mouse model of GFS. The 1st group received a subconjunctival (SC) injection of bevacizumab (1 μl; 25 μg); the 2nd group was treated during surgery with MMC (sponge soaked with MMC 0.02% for 2 minutes). Group 3 received a combination of MMC and a SC bevacizumab injection. Treatment outcome was studied by clinical investigation of bleb area and survival every other day. (Immuno)stainings were performed to study angiogenesis (CD31) and fibrosis (Sirius Red) on postoperative day 14 and 30. VEGF-levels after MMC treatment were measured in rabbit aqueous humor (AH) samples by ELISA.

Results

Bevacizumab and MMC were equally effective in improving surgical outcome. In both groups, bleb area was significantly improved with 53%, compared to control (NaCl). Blood vessel density and fibrosis were equally reduced, with 37% and 22%, respectively. Remarkably, one day after surgery, VEGF levels were significantly increased with 90% in the AH of MMC-treated eyes compared to control treated eyes. As compared to MMC monotherapy, combination of MMC and bevacizumab was able to increase bleb area with 18% by an additional reduction of angiogenesis and fibrosis, with 17% and 10%, respectively.

Conclusion

Our data suggest that bevacizumab together with MMC may have complementary effects, due to upregulation of VEGF after MMC treatment.

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