Efficacy of Bevacizumab and a Bevacizumab-Methylcellulose Mixture on Intraocular Pressure After Deep Sclerectomy: A Double-Blind, Randomized Controlled Clinical Trial

Introduction: This study aimed to compare the effectiveness of bevacizumab administered alone versus combined with methylcellulose in reducing intraocular pressure during a six-month period following deep sclerectomy. Methods: This comparative investigation, serving as an extension of a prospective randomized controlled trial, enrolled 30 eyes from 30 individuals diagnosed with open-angle glaucoma (15 eyes assigned to each treatment arm). Among participants, 33.3% presented with secondary open-angle glaucoma (pseudoexfoliation syndrome), while 66.7% had primary open-angle glaucoma requiring deep sclerectomy. Postoperatively, Group A received subconjunctival bevacizumab injections, whereas Group B received subconjunctival injections of a bevacizumab-methylcellulose mixture. Primary outcome measures included surgical success rates and bleb morphology assessment. Results: Among eligible participants, 66.7% were male and 33.3% were female. Visual acuity measurements demonstrated no significant intergroup differences before or after surgery. Although Group B exhibited greater IOP reduction compared to Group A, statistically significant differences between groups emerged only at postoperative day one and at the six-month follow-up assessment. Success rates (complete or relative success) at six months showed no statistically significant variation between groups (*P*>0.05), nor did mean preoperative and postoperative values with standard deviations differ significantly. Vascularity scores decreased markedly in Group B at one-month, three-month, and six-month evaluations relative to Group A. Conclusion: Utilizing a sustained-release delivery system that extends bevacizumab bioavailability appears to enhance surgical outcomes compared to conventional isolated bevacizumab ocular injections.