Intravitreal bevacizumab at trabeculectomy improved three-year surgical success in a randomised trial

The edition in brief

A single-centre, double-masked randomised trial gave 131 patients having trabeculectomy with mitomycin C either one intraoperative intravitreal injection of bevacizumab 1.25 mg or placebo. At 36 months, surgical success was higher with bevacizumab (hazard ratio for losing complete success 0.17, p=0.002), and fewer patients needed topical drops at every time point. A retrospective study of 150 treated glaucoma eyes using home rebound tonometry found that how often and how far pressure exceeded each patient's target at home was associated with faster visual field loss, while standard metrics and clinic-derived equivalents were not. A prospective, non-randomised Indian study of 152 patients with primary open-angle glaucoma found phacoemulsification with gonioscopy-assisted transluminal trabeculotomy lowered pressure and drop use about as much as phacotrabeculectomy at one year, with more hyphaema but no hypotony. The pearl covers recognising acute angle closure outside the eye clinic.