A systematic review and meta-analysis of clinical outcomes of vitrectomy with or without intravitreal bevacizumab pretreatment for severe diabetic retinopathy

Abstract

AimsTo examine possible benefits of intravitreal bevacizumab (IVB) pretreatment in vitrectomy for severe diabetic retinopathy.MethodsA comprehensive literature search was performed using the Cochrane Collaboration methodology to identify randomised controlled trials and comparative studies of vitrectomy with or without IVB pretreatment for severe or complicated diabetic retinopathy. Meta-analyses were performed for intraoperative (including intraoperative bleeding, endodiathermy, iatrogenic retinal tears and mean surgical time) and postoperative outcome parameters (including best-corrected visual acuity, recurrent vitreous haemorrhage, reabsorption time of blood and other complications).ResultsSix randomised controlled trials and one comparative study were identified and used for comparing vitrectomy alone (142 eyes, control group) with vitrectomy with IVB pretreatment (139 eyes). The intraoperative findings showed that the incidence of intraoperative bleeding and frequency of endodiathermy were statistically significantly less in the IVB pretreatment group (p<0.01) than in the vitrectomy alone group. The IVB pretreatment group took significantly less surgical time than the control group (p=0.003). Postoperative results indicated that reabsorption time of blood was significantly shorter (p=0.04), incidence of recurrent VH was almost significantly less (p=0.05), and final best-corrected visual acuity was significantly better (p=0.003) in the IVB group than in the control group. Other complications, including final retinal detachment, and reoperation, were statistically insignificant.ConclusionIVB pretreatment in vitrectomy can achieve excellent clinical outcomes for severe diabetic retinopathy. It potentially facilitates surgeons' manoeuvres and reduces intra- and postoperative complications.

Bevacizumab as an adjunct to vitreoretinal surgery for diabetic retinopathy in East Africa

“…Bevacizumab, a vascular endothelial growth factor antibody, induces regression of the vascular component of the fibrovascular membranes (FVMs). [3][4][5] This facilitates segmentation and delamination of membranes, as they are less adhesive to the underlying retina and are more readily separated. 6 IVB has also been shown to decrease intraoperative haemorrhage.…”

A review of anti-VEGF agents for proliferative diabetic retinopathy

“…83 The surgical time was shorter in the IVB pre-treatment group (Po0.01). Postoperative results showed great promise with shorter absorption of blood (P ¼ 0.04), significantly less incidence of recurrent VH (P ¼ 0.05), and a better final BCVA (P ¼ 0.003) in the IVB group than in the control group.…”

Preoperative Timing of Intravitreal Bevacizumab Injection for Proliferative Diabetic Retinopathy Patients

“…Preoperative IVB is administered before pars plana vitrectomy (PPV) to assist in the management of PDR-related complications, such as vitreous hemorrhages and tractional retinal detachment (TRD) [11-14]. Although, anti-VEGF therapy marks a major advance in the management of PDR, vitreoretinal fibrosis can develop or progress after IVB.…”