Bevacizumab Pretreatment and Long-acting Gas Infusion on Vitreous Clear-up After Diabetic Vitrectomy

Yang, Chung-May; Yeh, Po-Ting; Chen, Muh‐Shy

doi:10.1016/j.ajo.2008.04.028

Cited by 70 publications

(54 citation statements)

References 17 publications

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“…The same author showed that preoperative bevacizumab injection, such an anti-VEGF, in adjunct to long-acting postoperative tamponade (10% C 3 F 8 ) increases the clearance of early postoperative VH (7.2 ± 5.6 days vs 15.2 ± 11.4 days in no pretreatment group). 8 In our series, the incidence of VH after PPV does not differ in the initial postoperative period, but in long-term follow-up, the recurrence rate seems to be less than reported in previous literature data. 1,2 Our hypothesis is that the preoperative bevacizumab injection minimize the intraoperative bleeding during the delamination manoeuvre of the fibrovascular tissue.…”

Section: Discussioncontrasting

confidence: 53%

“…[6][7][8] Because of its almost immediate effect on the perfusion of ocular neovascularizations, it might have the potential to decrease the blood flow in neovascular tissues, and thereby decrease the incidence of rebleedings following vitrectomy for PDR. This prospective, interventional, consecutive case series describes our initial experience with IVB in the week before surgery for preventing post-vitrectomy diabetic VH.…”

Section: (Ppv)mentioning

confidence: 99%

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Can a preoperative bevacizumab injection prevent recurrent postvitrectomy diabetic vitreous haemorrhage?

Romano

Gibran

Marticorena

et al. 2008

Eye

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Aims To evaluate the recurrence rate of vitreous haemorrhage (VH) in patients treated with one intravitreal bevacizumab (IVB) injection (2.5 mg/0.1 ml) before planned pars plana vitrectomy for treatment of diabetic nonclearing VH. Methods Prospective pilot study of 32 eyes of 31 consecutive diabetic patients who underwent IVB injection within 1 week before surgery for persistent VH in the presence of active proliferative diabetic retinopathy. Three masked retinal specialists graded the amount of VH from grade 0 to grade 3 with slit-lamp biomicroscopy. Main outcome measures were the rate of recurrence of the VH, improvement in visual acuity, incidence of cataract formation, and postoperative complications through a followup of 6 months. Results The percentage of severe recurrent VH with no fundus details (grade 3) was 3% at 1 week follow-up and 3, 6, and 6% respectively at 1-, 3-, and 6-month follow-up. The mean best-corrected visual acuity (BCVA) improved from 1.6 (1/60) to 0.40 (6/15) logMAR (P ¼ 0.02) in 29 out of 32 eyes (91%). In all, 12 out of 22 (54%) phakic eyes developed cataract during the follow-up period, and 10 (31%) of them underwent cataract surgery. Conclusions Our study suggests that IVB injection few days before planned surgery seems to be efficacious and safe as an adjuvant treatment to prevent rebleeding in eyes undergoing pars plana vitrectomy for treatment of diabetic vitreous haemorrhage. IVB facilitates the surgery and reduces the need for extensive delamination and segmentation, decreasing the possibility of significant early active postoperative VH.

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Section: Discussioncontrasting

confidence: 53%

Section: (Ppv)mentioning

confidence: 99%

Can a preoperative bevacizumab injection prevent recurrent postvitrectomy diabetic vitreous haemorrhage?

Romano

Gibran

Marticorena

et al. 2008

Eye

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“…32,33 More recently, intravitreal anti-VEGF therapy with bevacizumab administered 1-2 weeks pre-operatively has been reported to provide some benefit. [34][35][36] Early vitreous cavity haemorrhages usually clear spontaneously within 2-6 weeks without requiring further intervention.…”

Section: Complications After Diabetic Vitrectomymentioning

confidence: 99%

Surgical management of the late complications of proliferative diabetic retinopathy

Newman

2010

Eye

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The late complications of proliferative diabetic retinopathy (PDR) comprise vitreous haemorrhage, tractional retinal detachment, combined tractional-rhegmatogenous retinal detachment, and severe fibrovascular proliferation (including macular distortion or dragging, tractional macular oedema, and media opacity due to fibrovascular tissue). This article will review the indications, techniques, and outcomes of vitrectomy surgery to treat these conditions. A careful assessment of the surgical anatomy, with particular attention to the configuration of vitreoretinal attachments, is important when determining the precise surgical procedure required. The surgical outcome after diabetic vitrectomy has steadily improved with advances in vitreoretinal surgical instrumentation and technique. Significant post-operative complications may, however, occur including cataract formation, recurrent vitreous cavity haemorrhage (early or delayed), rhegmatogenous retinal detachment, and neovascular glaucoma. Most patients will regain or retain useful vision after diabetic vitrectomy, although the visual outcome does remain unpredictable. The development of adjunctive pharmacotherapy should enable further improvements in visual outcome in the future.

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“…1 This gas is a long-acting gas with haemostatic effect, which could explain the absence of early POVCH. In our series, we did not use any gas at the end of the surgery.…”

mentioning

confidence: 99%

“…Phacoemulsification is the commonest procedure, with over 325 471 surgeries being performed in the NHS. 1 Identifying and stratifying the pre-operative risk for cataract surgery is probably more relevant now than before. This is especially so because of the relative reduction in ophthalmic training years and the adverse case mix because of case selection by local independent cataract treatment centres.…”

mentioning

confidence: 99%

Reply to Smith et al

Romano

Gibran

Marticorena

et al. 2009

Eye

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Bevacizumab Pretreatment and Long-acting Gas Infusion on Vitreous Clear-up After Diabetic Vitrectomy

Cited by 70 publications

References 17 publications

Can a preoperative bevacizumab injection prevent recurrent postvitrectomy diabetic vitreous haemorrhage?

Can a preoperative bevacizumab injection prevent recurrent postvitrectomy diabetic vitreous haemorrhage?

Surgical management of the late complications of proliferative diabetic retinopathy

Reply to Smith et al

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