Trabeculectomy with augmented adjunctive mitomycin-C and bevacizumab for persistent silicone oil induced glaucoma

Purpose: Was to provide a solution to the problem of persistent silicone oil induced glaucoma (SOIG), which represents a common type of intractable glaucoma that usually adds to the hazards of complicated vitreoretinal surgeries. The trial aimed to evaluate the efficacy and safety of an augmented adjunctive approach of various lines combined with surgical glaucoma treatment. Patients and Methods: Twenty-four eyes of 24 patients presented with SOIG were included in this interventional case series clinical trial. All eyes underwent trabeculectomy with intraoperative mitomycin-C (MMC) application plus bevacizumab injection (1.25 mg) together with early postoperative topical MMC drops (0.03 mg/ml). The main outcome results included the cumulative probability of surgical success, intraocular pressure (IOP) values, number of anti-glaucoma drugs needed, corrected distance visual acuity, any reported complication or additional intervention. Results: This combined approach achieved a cumulative probability of success of 0.765 at the end of the 24 months study period and was in a range of 0.883 at 2 weeks and 0.647 at 6 months. Complete success was achieved in a range of 82.4% at 2 weeks and 35.3% at 18 and 24 months. There were always highly statistically significant decreases in the mean IOP values and numbers of the given IOP-lowering drugs at all postoperative time points (P was always <0.001). All complications were controlled with no major drawbacks. No significant adverse effects were caused by this combined approach. Conclusion: The combined approach could present an efficient, safe, familiar, and applicable treatment strategy for the treatment of persistent SOIG. It can provide a favorable long-term outcome representing a simple solution to the problem of persistent SOIG, which represents a challenging type of refractory glaucoma.