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

Abstract

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.

Bevacizumab prior to vitrectomy for diabetic traction retinal detachment

“…Regarding recurrent VH; although we did not see a significant difference between the IVB and non-IVB groups, others have reported that preoperative IVB did lower the incidence of postoperative VH. 7,9,[12][13][14] The main limitation of our study was the selection of patients for preoperative IVB. Initially, in 2006, when we started using this adjunct for PPV, there was a selection bias for using IVB in eyes with more vascular membranes.…”

“…This vascular endothelial growth factor inhibitor has been reported to decrease intraoperative hemorrhage and facilitate fibrovascular membrane dissection, [3][4][5][6][7][8][9][10][11][12] and reduce postoperative vitreous hemorrhage (VH) rates. 9,[12][13][14] However, these studies were limited by relatively small numbers, heterogeneous retinal pathology (TRD and VH were studied together), and varying surgical techniques (multiple surgeons and multiple gauge vitrectomies). Concern still exists that IVB may worsen TRD, 6,[15][16][17] and may cause the foveal vascular zone enlargement.…”

Use of intravitreal bevacizumab or triamcinolone acetonide as a preoperative adjunct to vitrectomy for vitreous haemorrhage in diabetics

“…The preoperative injection of intravitreal bevacizumab may reduce intraoperative bleeding during dissection of membrane in PDR with tractional retinal detachment (17) . Intravitreal bevacizumab injection may not prevent postoperative VH, probably due to washing of bevacizumab during vitrectomy (20) . In this study, immediate postoperative VH occurred in 1 eyes in group 1, 4 eyes in group 2 and 8 eyes of the control group.…”

Antiangiogenic drugs and advanced proliferative diabetic retinopathy

“…Also, a pilot study of bevacizumab injected immediately after vitrectomy for vitreous hemorrhage was conducted (32) . In these studies, the bevacizumab dose ranged from 1 to 2.5 mg and the time of drug administration before surgery ranged from 1 to 30 days, with the patients usually being operated about 7 days after the intravitreal injection (18)(19)(20)22,(26)(27)(28)(29) . This time is considered to be safe in order to avoid complications of increased fibrosis and vitreoretinal traction, with regression of active neovessels and reduction of high VEGF levels characteristic of PDR having been observed (33) .…”

“…Bevacizumab has been used preoperatively as an adjuvant in vitrectomy in patients with TRD, vitreal hemorrhage, mixed TRD, active fibrovascular proliferation (FVP) (3,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) , and neovascular glaucoma (31) (Table 1). Also, a pilot study of bevacizumab injected immediately after vitrectomy for vitreous hemorrhage was conducted (32) .…”