Bevacizumab Was Combined With 5-Fu And MMC For Experimental Glaucoma Filtration Surgery

Abstract.This study evaluated the use of combined bevacizumab(BVZ)with 5-fluorouracil(5-FU)or mitomycin C(MMC)on postoperative scarring and bleb survival after experimental trabeculectomy.Methods.To assess the cytotoxicity of BVZ,5-Fu,MMC,BVZ/5-Fu,BVZ/MMC on ARPE19 cells,the amount of cell proliferation was determined by MTT assay.Concentrations of VEGF in the medium of the cultured ARPE19 cells were determined by ELISA.Cell cycle and apoptosis study were measured by flow cytometry.An in vitro scratch wound assay was performed on HUVECs and analysed to compare the migration relative speed of cells treated with drug-added medium.Trabeculectomy was performed 60 New Zealand White rabbits.The rabbits were allocated to one of six treatments:subconjunctival BVZ(ScB)alone,5-FU alone,MMC alone,combined ScB with 5-FU,ScB combined with MMC,or no adjuvant.The subconjunctival injections were administered immediate postoperatively.Clinical assessment and bleb photography were performed.Histologic and Masson staining determined the presence of subconjunctival fibrosis and mRNA expression of collagen I and fibronectin in the tissue was quantified.Results.No cytotoxicity was detectable for BVZ in concentrations up to 2.5 mg/ml on ARPE19 cells.The significance improving viability of cells was observed when 2.5mg/ml BVZ was simultaneously added to the cell culture of 0.5,5mg/ml 5-Fu groups.There was a significant decrease in protein levels of VEGF in BVZ/5-Fu groups.BVZ/5-Fu and BVZ/MMC could prolong the G1/G0 phase of RPE cells,and the combined drugs could induce the apoptosis of RPE cells and inhibit the migration of HUVEC.Increased bleb survival was associated with the combined treatment of ScB/5-Fu,ScB/MMC,and MMC alone.Histologic staining and Masson trichrome stained revealed a more loose arrangement of collagen fibers in the subconjunctival space in these 3 groups at day 56.Mild conjunctival vascularity appeared in ScB/5-Fu group.A significant reduction in transcript levels of collagen I and fibronectin mRNA were found in the ScB-treated,combined ScB and 5-Fu and combined ScB and MMC treatments.Conclusions.The combined BVZ and 5-Fu and combined BVZ and MMC treatments could offer effectively antifibrosis in a model of trabeculectomy,prolonging the survival of the filter bleb compared with BVZ or 5-Fu alone,but not MMC.Purpose:To assess the vision health-related quality of life(VRQOL)of Chinese glaucoma patients and the impact of potential influencing factors.Methods:A total of 202 glaucoma patients were enrolled in the study.The VRQOL was evaluated using the Chinese-version low vision quality of life questionnaire(CLVQOL).Visual field(VF)loss was classified by the Hodapp-Parrish-Anderson method.The correlations of VRQOL to the best corrected visual acuity(BCVA)and the VF loss were investigated.The potential impact factors to VRQOL of glaucoma patients were screened by single factor analysis,and were further analyzed by multiple regression analysis.Results:The mean VRQOL score was 92.08(23.97),ranging from 11 to 125.There were significant differences in VRQOL scores between mild VF loss group and moderate VF loss group,moderate VF loss group and severe VF loss group,and mild VF loss group and severe VF loss group according to the better eye(P=0.014,0.016,<0.001).In multiple linear regression,the binocular weighted average BCVA(P<0.001)significantly affected the VRQOL scores.Binocular MD was the second influencing factor(P=0.063).In logistic regression,binocular severe VF loss(P=0.004)and stroke P=0.016)were significantly associated with abnormal VRQOL.Education was the next influencing factor(P=0.052).Conclusions:This study in the Chinese glaucoma patients showed that visual acuity correlated linearly with VRQOL,and VF loss might reach a certain level,correlating with abnormal VRQOL scores.In addition,stroke was significantly associated with abnormal VRQOL.