Comparative evaluation of post-operative change in endothelial cell count using subconjunctival mitomycinc or bevacizumab as an adjunct to trabeculectomy: a pilot study

Purpose: Mitomycin-C (MMC) is an useful adjunct in high risk glaucoma surgery. Few clinical data both supporting and negating the role of Mitomycin C exist regarding potential deleterious effect of MMC on corneal endothelium. Subconjunctival or intracameral Bevacizumab is used as an adjunct to trabeculectomy. Bevacizumab has been found to be relatively safe when used intracamerally or intravitreally. No study has reported effect of Subconjunctival Bevacizumab on corneal endothelium in patients undergoing trabeculectomy. We intend to compareand also retrospectively analyze the two groups from past clinical data on Central endothelial cell density (CECD) postoperatively.
Methods: It is prospective, randomized study done on forty eyes of thirty-five adult patients with POAG or PACG were randomized to two groups, A and B respectively. Group-A underwent trabeculectomy with subconjunctival injection of Bevacizumab at the end of surgery adjacent to the bleb. Group B underwent trabeculectomy with subconjunctival 0.2mg/ml MMC applied for 2 minutes. Preoperative and postoperative CECD at day 7 and day 120 were analysed.
Results: Pre-operative, post-operative day 7 and day 120 specular counts were 2318.97±422.23/mm2, 2177.13±394.24/mm2 and 2170.3±411.78/mm2 respectively in Group A and pre-operative, post-operative day 7 and day 120 post-op specular counts were 2420.56±513.79/mm2, 2175.11±478.48/mm2 and 2148.94±451.14/mm2 respectively in Group B. There was significant decrease in the two groups postoperatively however the intergroup variation was not significant
Conclusion: There is a significant loss of corneal endothelial cells three months after trabeculectomy with both Subconjuctival Bevacizumab and Mitomycin C. However, post trabeculectomy endothelial cell loss appears to be multifactorial in nature and not solely due to adjuncts.