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The following is a summary of “Trabeculectomy Augmented with Anti-VEGF Improves Surgical Outcomes in Glaucoma: A Systematic Review and Meta-analysis,” published in the May 2025 issue of American Journal of Ophthalmology by Ramji et al. 

Trabeculectomy was recognized as the gold standard surgery for glaucoma but showed variable success due to fibrosis, leading to investigations of anti-VEGF agents as adjuncts to improve outcomes.  

Researchers conducted a retrospective study to compare the effectiveness of trabeculectomy with and without anti-VEGF augmentation for treating adults woth glaucoma.  

They registered the systematic review and meta-analysis on PROSPERO (CRD42025636060) and searched Medline, EMBASE, and Web of Science for randomized controlled trials (RCTs) comparing trabeculectomy with and without anti-VEGF agents in glaucoma. Primary outcomes included complete and qualified success rates, mean IOP reduction, and reduction in IOP-lowering medications. Follow-up periods were 6, 12, and 24 months. Meta-analyses were performed using Review Manager (version 5.4).  

The results showed that 16 studies with 1,002 patients were included. At 12 months, trabeculectomy combined with mitomycin C (MMC) and anti-VEGF) had higher odds of complete success (OR = 1.90, 95% CI 1.16–3.10, P= 0.01). Intracameral or intravitreal bevacizumab, particularly at 1.25 mg, improved complete success odds (OR = 1.58, 95% CI 1.06–2.36, P= 0.03). Trabeculectomy with MMC and bevacizumab also significantly lowered the need for IOP-reducing medications (MD = 0.34, 95% CI 0.09–0.60, P= 0.008). Risk-of-bias assessment rated 11 studies as low risk and 5 with some concerns.  

Investigators concluded that the adjunctive use of anti-VEGF agents with MMC in trabeculectomy procedures enhanced the outcomes by increasing complete success rates and decreasing the need for medication. 

Source: ajo.com/article/S0002-9394(25)00237-5/abstract