Effect of Bevacizumab Injection before Vitrectomy on Intravitreal Hemorrhage in Pseudophakic Patients with Proliferative Diabetic Retinopathy

Abstract

We evaluated the effect of intravitreal bevacizumab (IVB) injection before pars plana vitrectomy (PPV) on intravitreal hemorrhage (VH) during and after vitrectomy for postoperative the first day and the first month in pseudophakic patients with proliferative diabetic retinopathy (PDR). This retrospective study was performed on 44 eyes of 44 patients who underwent vitrectomy for PDR. Patients were divided into PPV (n = 22 eyes) and PPV + IVB (n = 22 eyes) groups. Injection of bevacizumab (1.25 mg/0.05 mL) was performed 3 days before vitrectomy. Outcomes of visual acuity as well as intraoperative and postoperative VH were compared between the two groups. One month after surgery, visual acuity improved in PPV and PPV + IVB groups (P = 0.005, P = 0.006), respectively. There was no difference between the two groups in best corrected visual acuity at baseline and after vitrectomy (P = 0.71). Intraoperative bleeding into the vitreous was recorded in 14 (63.6%) cases in the PPV group and in 7 (31.8%) cases in the PPV + IVB group. The first month, intravitreal hemorrhage was recorded in six patients in the PPV group and in two patients in the PPV + IVB group (P = 0.03). The mean pre-postoperative central macular thickness was similar in both groups. Intravitreal injection of IVB before vitrectomy decreased the rate of VH at the time of surgery and at the first postoperative month in patients with PDR.

Intravitreal ranibizumab injection at the end of vitrectomy for diabetic vitreous hemorrhage (Observational Study)

“…The reported prevalence of PDVH (occurring 1 or more weeks after surgery) is between 20% and 30%. [4,16] Many studies report that intravitreal anti-VEGF drugs administered before surgery can significantly reduce the probability of PDVH [1,16,28] ; however, other studies have contradicted these results and shown that these drugs fail to prevent PDVH. [23,29,30] Although definitive conclusions cannot be drawn, all studies [23,29,30] have shown that injection of anti-VEGF drugs (Bevacizumab and Ranibizumab) is helpful for limiting fibrovascular proliferation before vitrectomy, makes surgery easier, decreases surgical time, and reduces the frequency of endodiathermy.…”

“…Other studies have shown intravitreal Bevacizumab (IVB) to be safe and effective in reducing the incidence of recurrent postoperative VH. [17,28,37] The IVB injection also does not carry the risk of an early temporary rise in IOP that is seen with the IVT injection. Both Bevacizumab and Ranibizumab have been reported to cause regression of neovascularization in eyes with active progressive PDR.…”

Change of ranibizumab-induced human vitreous protein profile in patients with proliferative diabetic retinopathy based on proteomics analysis

“…As an anti-VEGF agent, ranibizumab is an engineered, humanized, recombinant antibody fragment active against all VEGF-A isoforms and has a shorter half-life than other similar agents [ 3 ]. Increasing evidences showed that preoperative anti-VEGF treatment reduces the risk of intraoperative or postoperative bleeding in PDR patients and improves best corrected visual acuity (BCVA) [ 4 – 8 ]. Recently, we found that preoperative intravitreal injection of ranibizumab (IVR) for patients with severe proliferative diabetic retinopathy (PDR) contributed to a decreased risk of postoperative neovascular glaucoma [ 9 ], which is among the most serious postoperative complication of PDR.…”

Role of bevacizumab in the prevention of early postoperative haemorrhage after 25-gauge microincision vitrectomy surgery

“…It is possible that for less experienced surgeons, avoiding intra-operative bleeds may have a significant improvement on the total surgery time by providing a clearer view during surgery. The reduction in surgical time in patients receiving IVB before vitrectomy has also been reported by several authors 16,20,21. This is the consequence of less instrumentation requirement, clearer view during vitrectomy, reduced risk of creating iatrogenic breaks and easier dissection of membranes and decreased need of endolaser 12…”