Bevacizumab sustains trabeculectomy success

John A. Landers and colleagues reported a 3-year follow-up showing that a single intraoperative dose of intravitreal bevacizumab improved trabeculectomy survival when added to mitomycin-C in patients undergoing surgery for progressing glaucoma. The report was published in *Ophthalmology* in May 2026 and follows an earlier 12-month randomized trial from the same group. The study tested whether a one-time anti-VEGF injection given during surgery could reduce later bleb failure, a common cause of trabeculectomy breakdown. Medscape described the new paper as showing higher long-term bleb survival with the bevacizumab approach. ### Which patients were studied, and how was the trial set up? The 12-month BMJ report said the trial was a single-center, parallel, double-blinded, randomized, placebo-controlled study in patients requiring trabeculectomy for progressing glaucoma. Patients were randomized to receive intravitreal bevacizumab or placebo during a standardized trabeculectomy procedure augmented with mitomycin-C, according to the paper. The primary outcome defined success by whether intraocular pressure stayed below a predefined target, with or without topical medication. (aaojournal.org) The BMJ paper said 131 patients were randomized, with 65 assigned to bevacizumab and 66 to placebo, and 128 completed 12 months of follow-up. The authors listed on that report were Landers, Sean Mullany and Jamie E. Craig, all affiliated with Flinders University of South Australia in Adelaide. ### What did the earlier trial show before the 3-year update? (bjo.bmj.com) At 12 months, the BMJ paper reported higher success rates in the bevacizumab group than in the placebo group. Complete success was 94% versus 83%, and qualified success was 98% versus 90%, the paper said. The placebo group also had a higher need for topical therapy at 6 and 12 months and a higher need for bleb needling at 1 month. (bjo.bmj.com) The same report said blebs in the bevacizumab group were larger at 1 month and showed less vessel inflammation. The authors concluded that a single intravitreal dose during trabeculectomy with mitomycin-C improved surgical success at 12 months and reduced the need for additional medication or further surgery to reach target intraocular pressure. (bjo.bmj.com) ### What does the new 3-year follow-up add? The *Ophthalmology* article published last week states that higher rates of 3-year success were observed after trabeculectomy with mitomycin-C when a single intraoperative dose of intravitreal bevacizumab was used. PubMed’s abstract summary says the study evaluated the effect of that dose on surgical success over three years. The Medscape report said the key long-term signal was better bleb survival than standard care. (bjo.bmj.com) The available summaries do not provide the full 3-year numerical breakdown in open text, but the direction of effect matches the 12-month randomized data and the earlier conference and journal reporting on the same trial. That link between early bleb appearance and later survival is an inference from the sequence of reports, not a direct quote from the authors. (aaojournal.org) ### Why would bevacizumab affect a trabeculectomy bleb? Trabeculectomy failure is often driven by postoperative wound healing, vascularization and scarring around the filtering bleb. The BMJ paper said anti-vascular endothelial growth factor therapy had been proposed as a way to incrementally improve outcomes with trabeculectomy. In that study, bevacizumab-treated blebs were described as larger and less inflamed early after surgery. (aaojournal.org) The *Ophthalmology* and PubMed summaries frame the benefit in terms of surgical success and survival rather than a change in the basic operation itself. The intervention was a single intraoperative injection, not a new implant or repeat postoperative regimen. ### What comes next for readers who want the details? The 3-year follow-up is available in *Ophthalmology* under the title “Intravitreal Bevacizumab Improves Trabeculectomy Survival at 3 Years,” and the earlier randomized trial is published in the *British Journal of Ophthalmology*. (bjo.bmj.com) Landers, Mullany and Craig are listed on the earlier paper, and the new report appears to extend that same study cohort. (aaojournal.org)