Intravitreal ziv-aflibercept in diabetic vitreous hemorrhage

Abstract

Background: To evaluate the safety and efficacy of intravitreal ziv-aflibercept (IVZ) in the management of vitreous hemorrhage (VH) in eyes with previously lasered proliferative diabetic retinopathy (PDR). Methods:In a prospective multicenter study, previously lasered eyes who had dense VH from PDR underwent intravitreal injection of ziv-aflibercept (IVZ) (1.25 mg aflibercept). Demographic characteristics of the patients, baseline and final logMar visual acuity, number of injections, VH clearance time, and need for vitrectomy were recorded.Results: Twenty-seven eyes of 21 patients were included in the study. Mean age of study patients was 61.3 ± 14.1 years with mean duration of diabetes mellitus of 22.6 ± 7.8 years. Mean logMAR BCVA at baseline was 1.41 ± 1.26 (Snellen equivalent 20/514) and at the last visit 0.55 ± 0.61 (Snellen equivalent 20/70) with a mean gain of 0.86 EDTRS line (paired student t test = 5.1; p ≤ 0.001). Mean number of IVZ 2.4 ± 1.6 (range 1-6). The mean follow-up time was 11.7 ± 11.1 months (range 1-34). Mean time for visual recovery and/or VH clearance was 5.7 ± 3.3 weeks. Eyes, which required multiple injections, the interval period between injections for recurrent VH was 6.4 ± 5.2 months. No subject required vitrectomy. No ocular or systemic adverse effects were noted.Conclusions: IVZ injections had good short-term safety and efficacy for the therapy of new or recurrent VH in previously lasered eyes with PDR reducing somewhat the need for vitrectomy. Trial registration: NCT02486484

Determining the Superiority of Vitrectomy vs Aflibercept for Treating Dense Diabetic Vitreous Hemorrhage: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

“…The literature search yielded 774 articles, of which 6 were eligible for inclusion. A full-text review identified four articles to be excluded (one uncontrolled study, 15 one study in which IVA was compared to sham treatment, 16 and two studies in which IVA was compared with PRP) 10 , 17 , and ultimately, only two articles were included in the qualitative and quantitative synthesis. The PRISMA flowchart for the selection of studies is shown in Figure 1 .…”

Review of the management of sight-threatening diabetic retinopathy during pregnancy

“…Despite vision improvement reported in approximately 75% of PDR patients after PPV, major complications associated with PPV include cataract formation, elevated intraocular pressure, recurrent vitreous cavity haemorrhage (early, delayed, or persistent), iatrogenic retinal breaks, tractional and rhegmatogenous retinal detachment, and neovascular glaucoma[ 109 ]. Several studies have been conducted on the use of anti-VEGF drugs as a treatment for VH due to PDR and found that intravitreal ranibizumab[ 110 ], bevacizumab[ 111 , 112 ], and aflibercept[ 113 ] had good short-term safety and efficacy for new or recurrent VH in PDR eyes with and without a previously lasered approach, reducing the need for PPV. As the use of anti-VEGF drugs is associated with pregnancy loss and foetal abnormalities, PRP and PPV remain the treatment of choice for VH in pregnant patients with PDR.…”

Commentary: Outcomes of preoperative bevacizumab in diabetics with nonclearing vitreous hemorrhage without tractional detachment – A quasi-randomized retrospective study

“…To mention, Ahmad M. Mansour et al . [ 8 ] studied the effects of ziv-aflibercept on VH in eyes with PDR status post pan-retinal photocoagulation and found its beneficial effects for the therapy of VH.…”