One bevacizumab injection at trabeculectomy: better survival at three years

Design

Single-centre, double-masked, randomised, placebo-controlled trial

Population

131 patients having trabeculectomy or phacotrabeculectomy with mitomycin C

Primary outcome

Complete and qualified surgical success at 36 months

Effect

HR 0.17 (complete, P = 0.002) and 0.07 (qualified, P = 0.03) favouring bevacizumab

This single-centre, double-masked, placebo-controlled trial randomised 131 patients needing primary or redo trabeculectomy, or phacotrabeculectomy, with mitomycin C to a single intraoperative intravitreal injection of bevacizumab 1.25 mg or balanced salt solution. 111 (85%) completed three years. The three-year results were published in May 2026.

Trabeculectomy survival was higher with bevacizumab, with hazard ratios of 0.17 for complete success and 0.07 for qualified success favouring the injection (P = 0.002 and 0.03). Patients given placebo needed glaucoma drops more often at every time point from three months to three years. Confidence intervals were not reported in the abstract.

Bevacizumab is inexpensive and widely used intravitreally in India, but its use here is off-label. The trial is single-centre, the effect size looks unusually large, and intravitreal injection carries its own small risks. It is a strong signal worth adopting carefully in units that already give intravitreal injections, and worth confirming in a multicentre trial.

• Consider a single intravitreal bevacizumab dose at trabeculectomy with mitomycin C in eyes at high risk of failure.
• Explain to patients that this is an off-label use and obtain informed consent.
• Use the standard aseptic precautions for intravitreal injection.
• Audit bleb survival and drop use in your own unit if you adopt it.

Why it matters

Bleb scarring is the main reason trabeculectomies fail, and this is a cheap, available way to target it.

Don't overread it

A single-centre trial with no confidence intervals in the abstract; the very large effect needs confirmation.

The statistics, in plain English

Hazard ratios this far below 1 indicate a much lower rate of losing success over time with bevacizumab. Very large effects from a single trial often shrink when repeated, so a confirmatory study matters.

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