Preoperative Bevacizumab for Tractional Retinal Detachment in Proliferative Diabetic Retinopathy: A Prospective Randomized Clinical Trial

Abstract

PURPOSE: To assess the effectiveness and safety of an intravitreal injection of 1.25 mg bevacizumab (IVB) as a preoperative adjunct to small-gauge pars plana vitrectomy (PPV) compared with PPV alone in eyes with tractional retinal detachment secondary to proliferative diabetic retinopathy.METHODS: This prospective, double-masked, randomized, multicenter, active-controlled clinical trial enrolled 224 eyes of 224 patients between November 2013 and July 2015. All eyes underwent a baseline examination including best-corrected visual acuity, color photos, optical coherence tomography, and fluorescein angiography. Data were collected on intraoperative bleeding, total surgical time, early (<1 month) postoperative vitreous hemorrhage, and mean change in best-corrected visual acuity at 12 months. P < .05 was considered statistically significant. RESULTS: A total of 214 patients (214 eyes) were randomized in a 1:1 ratio to PPV plus IVB ([study group] 102 eyes) or PPV plus sham ([control] 112 eyes). Iatrogenic retinal breaks were noted intraoperatively in 35 eyes (34.3%) in the study group, and 66 eyes (58.9%) in the control group (P [ .001). Grade 2 intraoperative bleeding was noted in 32 (31.3%) eyes in the study group and 58 (51.7 %) eyes in the control group (P [ .001). Endodiathermy was necessary in 28 (27.4 %) eyes in the study group, compared with 75 (66.9%) eyes in the control group (P [ .0001). Mean surgical time was 71.3 ± 32.1 minutes in the study group and 83.6 ± 38.7 minutes in the control group (P [ .061). CONCLUSION: Preoperative IVB seems to reduce intraoperative bleeding, improving surgical field visualization, and reducing intraoperative and postoperative complications. NOTE: Publication of this article is sponsored by the

Effect of intravitreal conbercept injection on VEGF‑A and ‑B levels in the aqueous and vitreous humor of patients with proliferative diabetic retinopathy

“…neovascularization leads to vitreous opacity, retinal proliferative membrane occurrence, retinal traction detachment and impaired visual function (19). Furthermore, intraoperative bleeding affects the surgical field and prolongs the operation time (23). The present results demonstrated that intraoperative bleeding was reduced in the combined drug treatment group during the PPV operation compared with that in the simple surgery group due to the reduced number of new blood vessels in the neovascular proliferation membrane of patients.…”

Eicosanoid Profiles in the Vitreous Humor of Patients with Proliferative Diabetic Retinopathy

“…The decision of whether to treat an eye with bevacizumab prior to surgery is primarily a surgeon preference (SSRI, CJ); intravitreal administration of bevacizumab prior to surgery decreases intra-operative bleeding and makes surgical dissection of tractional membranes less difficult [ 9 ]. Thus, pre-treatment of diabetic tractional retinal detachments can help improve surgical outcomes, especially with very complex tractional detachments [ 9 , 39 ]. This is the primary reason why so few samples were not treated with bevacizumab prior to surgery were available for this study.…”

Diabetic eye disease: A review of screening and management recommendations

“…Chronic TRDs (ie, >6 months) involving the macula may also benefit from surgery, but the visual prognosis remains guarded. Pre‐operative anti‐VEGF reduces the duration of vitrectomy and intraoperative and postoperative complications, including retinal breaks 90,91 . The surgical management of diabetic TRDs will not be covered in this review.…”

“…Pre-operative anti-VEGF reduces the duration of vitrectomy and intraoperative and postoperative complications, including retinal breaks. 90,91 The surgical management of diabetic TRDs will not be covered in this review.…”