Intravitreal injection of bevacizumab and triamcinolone acetonide at the end of vitrectomy for diabetic vitreous hemorrhage: a comparative study

Park, Dong Ho; Shin, Jae Pil; Kim, Si Yeol

doi:10.1007/s00417-009-1247-7

Cited by 32 publications

(22 citation statements)

References 44 publications

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“…9,12 IVB after a vitrectomy also appears safe and effective for reducing postoperative VH, albeit without the benefit on final visual acuity. 21,22 In a randomized clinical trial, 25.7% of patients avoided the need for vitrectomy after IVB injection. 23 Although PRP is the principal therapy for PDR, substantial regression of NV may take weeks after completion of laser treatment, and it is not always effective.…”

Section: Discussionmentioning

confidence: 99%

Intravitreal bevacizumab for proliferative diabetic retinopathy with new dense vitreous hemorrhage after full panretinal photocoagulation

Sinawat

Rattanapakorn

Sanguansak

et al. 2013

Eye

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Purpose To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) injections for the treatment of proliferative diabetic retinopathy (PDR) with new dense vitreous hemorrhage (VH) after previous full panretinal photocoagulation (PRP). Methods Prospective study of consecutive PDR with prior complete PRP patients, who presented with new dense VH, were treated with IVB injection. Complete ophthalmic examination and/or ocular ultrasonography were performed at baseline and 1, 6, and 12 weeks and 6, 9, and 12 months after the first injection. Reinjection was done in non-clearing and recurrent VH. Results Eighteen eyes of 18 patients, mean age 47.7±12.69 years were included. In all, 14 (77.78%) patients had type 2 diabetes mellitus. Systemic hypertension and dyslipidemia were the most common systemic diseases. All cases were phakic eye with previous complete PRP. Patients received 1.6±0.42 intravitreal injections over a 12-month period. VH cleared completely in 7 (38.89%), 9 (50%), and 13 (72.22%) eyes after 6 weeks, 6 months, and 12 months, respectively. Re-bleeding, however, occurred in 10 (56%) eyes during the follow-up period, and 5 (28%) eyes still had residual VH at the last visit. Statistically significant visual gain was observed in 9 (50%) eyes. Unfortunately, 2 (11%) eyes had severe visual loss because of the tractional retinal detachment (TRD). Mild ocular complication was detected in one patient.Conclusion IVB injection had good efficacy and safety for treatment of new VH in patients with PDR and prior complete PRP. This procedure may be especially relevant for diabetic patients at high-risk for surgical intervention.

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Section: Discussionmentioning

confidence: 99%

Intravitreal bevacizumab for proliferative diabetic retinopathy with new dense vitreous hemorrhage after full panretinal photocoagulation

Sinawat

Rattanapakorn

Sanguansak

et al. 2013

Eye

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“…Relatively fewer studies have investigated the use of intravitreal anti-VEGF agents at the end of surgery; unfortunately, such studies yielded controversial findings. Some of these studies [9][10][11] reported that the use of anti-VEGF agents could significantly reduce the incidence of postoperative VH. Others, however, suggested that intravitreal anti-VEGF had no beneficial effect upon the incidence of postoperative VH when injected at the end of surgery [12][13][14].…”

Section: Resultsmentioning

confidence: 99%

“…However, the results of such procedures remain controversial. Some authors have reported that when injected intraoperatively, anti-VEGF drugs could result in a reduction in the incidence of early recurrent VH and quicker absorption of recurrent VH [9][10][11]. Other studies, have reported the opposite effects [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

The effect of adjunctive intravitreal conbercept at the end of diabetic vitrectomy for the prevention of post-vitrectomy hemorrhage in patients with severe proliferative diabetic retinopathy: a prospective, randomized pilot study

Zhang

Chen

et al. 2020

BMC Ophthalmol

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Background: To investigate the effect of intravitreal conbercept (IVC) injections on the incidence of postoperative vitreous hemorrhage (VH) in eyes undergoing surgery for severe proliferative diabetic retinopathy. Methods: This was a pilot prospective, comparative, and randomized study. Thirty patients, who underwent vitrectomy for severe proliferative diabetic retinopathy, were assigned randomly to either group 1 (intravitreal conbercept [IVC] injection at the end of pars plana vitrectomy) or group 2 (no IVC injection). Postoperative followup was performed on the first day, first week, first month, third month, sixth month and first year after surgery. The primary outcome was the incidence of postoperative VH. Secondary outcomes were the initial time of vitreous clearing (ITVC), best-corrected visual acuity (BCVA) and central retinal thickness (CRT) after surgery. Results: A total of 30 eyes, from 30 patients, were included. Fifteen eyes were enrolled in the IVC group and fifteen in the control group. The incidence of early and late postoperative VH was not significantly different between the control and IVC groups. ITVC was shorter in the IVC group than that in the control group, but this was not significant (7.38 ± 10.66 vs 13.23 ± 17.35, P = 0.31). Final BCVA, 1 year after surgery, showed significant improvement compared to baseline in both groups. However, analysis of the BCVA at any postoperative visit after surgery showed no significant differences between the two groups. There were two cases of recurrent VH identified at 3 and 6 months after surgery in each group, requiring a second round of surgery. Foveal thickness was significantly different between the two groups at the 3-month, 6-month and 1-year follow-up visits. Conclusions: In this pilot study, the effect of IVC injection in reducing the incidence of postoperative VH after diabetic vitrectomy at the end of vitrectomy was not shown.

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“…23 Some investigators have suggested the use of bevacizumab at the end of operation to reduce postoperative hemorrhage induced by early growth of neovascularization. 24,25 We injected 0.05 mg of bevasizumab before silicone oil infusion in an attempt to inhibit early postoperative neovascularization. The exact effect of the treatment in a silicone oil-filled eye remains to be studied.…”

Section: Discussionmentioning

confidence: 99%

Distribution, reabsorption, and complications of preretinal blood under silicone oil after vitrectomy for severe proliferative diabetic retinopathy

Yeh

2012

Eye

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Purpose To examine the evolution and complications of preretinal hemorrhage under silicone oil after diabetic vitrectomy. Methods A total of 44 cases of primary diabetic vitrectomy with silicone oil infusion were reviewed in a 3-year period. Intravitreal bevacizumab was used preoperatively for cases with active proliferation, and in all cases at the end of surgery. Intraoperative bleeding, postoperative extent of preretinal hemorrhage, blood reabsorption time, and reproliferation and treatment results were assessed. Results Maximal blood distributed in thin and scattered patterns (23 cases), thick and localized patterns (10 cases), or thick and scattered patterns (10 cases) developed within 1 week after surgery, and was largely reabsorbed within a month with improved postoperative vision. Confluent blood extending to the midperiphery (one case) resulted in severe fibrosis and detachment. Complications included fibrotic plaque (two cases), and fibrous band and thick membrane (seven cases). Six cases underwent preretinal tissue removal. Vision improvementZ3 lines was noted in three cases. Conclusion Most of the rebleeding occurred within the first post-op week, with gradual reabsorption in the posterior pole within 4 weeks; widespread confluent bleeding might result in severe reproliferation and detachment. A major complication of preretinal bleeding was the formation of preretinal fibrosis. Re-operation achieved a mild VA improvement.

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Intravitreal injection of bevacizumab and triamcinolone acetonide at the end of vitrectomy for diabetic vitreous hemorrhage: a comparative study

Abstract: IVB and IVT injection at the end of diabetic vitrectomy is a useful adjunctive therapy for reducing early postoperative VH compared to the control group. IVB injection does not have a risk of a temporary rise of IOP, which the IVT group has.

Cited by 32 publications

References 44 publications

Intravitreal bevacizumab for proliferative diabetic retinopathy with new dense vitreous hemorrhage after full panretinal photocoagulation

Intravitreal bevacizumab for proliferative diabetic retinopathy with new dense vitreous hemorrhage after full panretinal photocoagulation

The effect of adjunctive intravitreal conbercept at the end of diabetic vitrectomy for the prevention of post-vitrectomy hemorrhage in patients with severe proliferative diabetic retinopathy: a prospective, randomized pilot study

Distribution, reabsorption, and complications of preretinal blood under silicone oil after vitrectomy for severe proliferative diabetic retinopathy

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