CLINICAL OUTCOMES OF PRESERFLO® MICROSHUNT PROCEDURE WITH MITOMYCIN C ALONE VERSUS WITH MITOMYCIN C AND BEVACIZUMAB

Published 2023 - 27th ESCRS Winter Meeting

Reference: P168 | Type: Presented Poster & Poster Submission | DOI: 10.82333/apfg-je90

Authors: Inas Mohamed Gadelkarim* ¹ , Gokulan Ratnarajan ² , Lee Jones ¹ , Umair Qidwai ²

¹Moorfileds Eye Hospital,London,United Kingdom, ²Queen Victoria NHS Foundation trust,East Grinstead,United Kingdom

Purpose

•The purpose of this study is to compare the outcomes of PRESERFLO® Microshunt procedure using MMC alone versus MMC augmented with intracameral Bevacizumab in patients with open angle glaucoma to a follow-up time of 6 months.

Setting

•Retrospective, single-surgeon case series of consecutive patients receiving PRESERFLO ® Microshunt.

Methods

•From December 2018 to January 2020, eligible patients underwent PRESERFLO® Microshunt implantation with MMC alone, while from February 2020 to January 2022, patients underwent PRESERFLO® Microshunt implantation with MMC and adjuvant anti-VEGF agent in the form of intracameral Bevacizumab, injected at the end of the procedure.

At 6 months of follow up, clinical outcomes were analysed in both groups:

•Efficacy outcomes were analyzed, including changes in IOP and changes in anti-glaucoma medication use.

•Postoperative complications and postoperative interventions were also reviewed.

Results

•A total of 75 eyes were included in the analysis, 38 eyes received MMC alone while 37 eyes received MMC combined with Bevacizumab.

•There were no statistically significant differences in the demographic or clinical profile of patients between treatment groups.

•Both strategies were effective in terms of IOP lowering (baseline versus 6 months postoperatively: 20.0 ± 6.8 mmHg versus 12.8 ± 3.7 mmHg in the MMC group; 23.6 ± 6.9 mmHg versus 11.9 ± 4.2 mmHg in the MMC+ Bevacizumab group; p<0.001 in both comparisons).

•Mean anti-glaucoma medication use also reduced significantly from baseline with no difference between both groups.

•At 3 months of follow up, there was a statistically significant difference in IOP between the Bevacizumab and control group , being lower in the Bevacizumab group (9.9 ± 2.6 mmHg versus 11.3 ± 3.8 mmHg; p=0.03).

•There was no statistically significant difference between the groups in the number of complications except for the higher rates of early bleb encapsulation and higher bleb vascularity scores in the MMC alone group.

•A higher proportion of patients required early postoperative interventions (5-FU injection, needling and bleb revision) in the MMC alone group (N=19; 50%) compared to the MMC+ Bevacizumab group (N=6; 16.2%) which was statistically significant (Pearson’s χ2 test; p=0.002).

Conclusion

•The adjuvant use of Bevacizumab in MMC-augmented PRESERFLO® Microshunt procedure is associated with lower IOP and better bleb morphology in the early postoperative period, when compared to MMC alone. Therefore, it could help reduce rates of postoperative interventions (injection, needling and revision) needed to maintain a functioning bleb.

•At 6 months of follow up, both approaches had similar safety and efficacy outcomes, but with higher rates of postoperative interventions in the MMC alone group.

•Further assessment of our cohort at 1 year and beyond is needed to report on the long term safety and efficacy outcomes.