Visual Outcomes and Incidence of Recurrent Vitreous Hemorrhage After Vitrectomy in Diabetic Eyes Pretreated With Bevacizumab (Avastin)

Abstract

Purpose To evaluate the safety and effect of bevacizumab pretreatment on incidence of recurrent vitreous hemorrhage and visual acuity after vitrectomy for proliferative diabetic retinopathy (PDR). Study Design Consecutive, retrospective, comparative cohort study Methods Patients undergoing vitrectomy from September 2006 through November 2007 at the Emory Eye Center for complications of PDR were identified and reviewed. A total of 33 eyes pretreated with bevacizumab and 104 eyes untreated were followed for postoperative vitreous hemorrhage and final visual acuity. Results Patients in the bevacizumab group were significantly younger than the untreated group (average age 46.4 vs. 58.4) and were more likely to have 20 ga instrumentation (58% vs. 36%). An average of 9.6 days passed between injection and surgery. Early (4-6 weeks) rebleed rates were 15% vs. 13% in the bevacizumab and untreated groups, respectively, and not statistically different. Preoperative (7/200 vs. CF 4′), 1 month postoperative (20/200-3 vs. 20/150), and 3 month postoperative visual acuity (20/100-3 vs. 20/100+2) were not statistically different between groups. No statistical difference was found in rebleed rates with regard to gauge of vitrectomy. Conclusions Bevacizumab pretreatment for diabetic vitrectomy was not associated with any observed complications, but may not influence rates of postoperative vitreous hemorrhage or final visual acuity. The overall incidence of postoperative early vitreous hemorrhage in this series was 13% and appears lower than historically reported rates.

Efficacy of Simultaneous Usage of Bevacizumab and Silicone Oil Injection After Vitrectomy in Diabetic Tractional Retinal Detachment

“…Several authors demonstrated 13 to 25% of vitreous hemorrhage following preoperative intravitreal bevacizumab (18,19). While, in our study no vitreous hemorrhage was detected postoperatively.…”

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).…”

Antiangiogenic drugs and advanced proliferative diabetic retinopathy

“…While some studies have reported a statistically significant postoperative gain of visual acuity in patients previously treated with bevacizumab (18)(19)(22)(23)29) , others did not observe this benefit (20)(21)24,28) . The occurrence of postoperative vitreous hemorrhage tends to be less frequent with the adjuvant use of bevacizumab (18)(19)(22)(23) , although this result was not observed in other studies (21,24,28) . Postoperative vitreous hemorrhage can also be combated with gas buffering, which proved to be as effective as preoperative bevacizumab in a study by Yeung et al (23) , although in that study the best results were obtained with the preoperative use of bevacizumab in combination with gas at the end of vitrectomy.…”

“…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) .…”