Avaliação de bolha fistulante antiglaucomatosa em olhos de coelhos após administração de Bevacizumabe, Acetato de Triancinolona e Mitomicina-C

Abstract

PURPOSE: To investigate the individual and synergistic mechanism of action of bevacizumab, mitomycin C (MMC), and triamcinolone acetonide (TA) during postoperative healing after glaucoma filtration surgery (GFS) in rabbits. METHODS: Both eyes of 45 rabbits of New Zealand breed were subjected to GFS. The rabbits received different treatments during the surgery, including saline solution, MMC, TA, TA + MMC, bevacizumab, and bevacizumab + MMC. MMC and saline solution were used below the conjunctival flap. TA and bevacizumab were used immediately after surgery as subconjunctival injections. The rabbits were evaluated on different days postoperatively. Intraocular pressure (IOP) was measured, and analysis of the bleb was done based on the Moorfields Grading System. The animals were sacrificed on postoperative days (PD) 3, 14, and 30. Histological and immunohistochemical examinations were conducted to assess healing. RESULTS: The bevacizumab + MMC group displayed the lowest IOP at the end of the study (7.7 ± 0.8 mm Hg), followed by MMC (8.8 ± 1.85 mm Hg) and AT + MMC (8.9 ± 0.9 mm Hg) (P = 0.001). The bevacizumab + MMC group displayed the best clinical results in relation to maximum height, central area, and maximum area of the bleb (P < 0.05). The TA + MMC group displayed higher blebs than the MMC group (P < 0.05). Analysis of vascularization of the central and maximum areas of the bleb revealed smaller values in the groups that used MMC on PD 14 and PD 30. During assessment of inflammatory infiltrates, the bevacizumab + MMC group had lower indexes in the whole study, followed by the TA + MMC and MMC groups (P = 0.001). Initially, vascular proliferation was lower in the TA + MMC group. In the intermediary stage, it was lower in the bevacizumab + MMC group. At the end of this study, the MMC group had the lowest indexes (P = 0.001). CONCLUSIONS: The combination of bevacizumab and MMC was effective and safe as a GFS healing modulator in this animal model. The combination of triamcinolone and MMC was also effective, but not so effective as bevacizumab + MMC. The isolated alternative modulators were not as effective as MMC monotherapy.