J Korean Ophthalmol Soc.  2009 May;50(5):731-737. 10.3341/jkos.2009.50.5.731.

Intravitreal Bevacizumab Injection as Preoperative Adjuvant of Vitrectomy for Proliferative Diabetic Retinopathy

• Shin MK
• Kim NM
• Lee JE
• Oum BS

• KMID: 2212309
• DOI: http://doi.org/10.3341/jkos.2009.50.5.731

Abstract

PURPOSE:The effect of preoperative intravitreal bevacizumab (Avastin(R)) injection was investigated in primary vitrectomy for severe proliferative diabetic retinopathy.
METHODS
Eyes that underwent vitectomy for proliferative diabetic retinopathy were followed up at least 6 months and were reviewed retrospectively. The authors reviewed functional outcomes, complications, and operation time between preoperative bevacizumab injection (group I) and non-injection groups(group II).
RESULTS
Among 93 eyes of 87 patients, the injection group consisted of 44 eyes of 41 patients and the non-injection gauge group consisted of 49 eyes of 46 patients. The mean interval between injection and vitrectomy was 5.8 days. Final visual acuity significantly improved as compared to preoperative visual acuity, and group I showed better visual acuity than group II (p=0.008). Visual acuity improved logMAR 0.2 or more in 36 eyes in group I and 43 eyes in group II (p=0.167). The average duration of postoperative vitreous hemorrhage was 1.02 days in group I, and 4.02 days in group II (p=0.2.08). Recurrence of vitreous hemorrhage was not observed in group I or in 2 eyes of group II (p=0.274). Epiretinal membrane occurred in 2 eyes of group I, and in 9 eyes of group II (p=0.031). Only a single eye in group I had neovascular glaucoma after vitrectomy (p=0.527). The operation time of group I was 64.8 minutes, which was significantly shorter than 78.1 minutes of group II (p=0.018).
CONCLUSIONS
Intravitreal bevacizumab injection before vitrectomy in proliferative diabetic retinopathy facilitated removal of the fibrovascular membrane, and leads to less postoperative complications and better functional outcomes. Intravitreal bevacizumab injection before vitrectomy can be considered as an effective preoperative adjuvant.

Keyword

Bevacizumab (Avastin); Diabetic retinopathy; Epiretinal membrane; Vitrectomy; Vitreous hemorrhage

MeSH Terms

Antibodies, Monoclonal, Humanized
Diabetic Retinopathy
Epiretinal Membrane
Eye
Glaucoma, Neovascular
Humans
Membranes
Postoperative Complications
Recurrence
Retrospective Studies
Visual Acuity
Vitrectomy
Vitreous Hemorrhage
Bevacizumab
Antibodies, Monoclonal, Humanized

Figure

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  Figure 1. Average visual acuity changes after vitrectomy with and without pre-operative intravitreal bevacizumab injection for proliferative diabetic retinopathy at baseline and over a 6-month period (* p=0.008, Student t-test).

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  Figure 2. Visual acuity distribution in proliferative diabetic retinopathy with (A) and without (B) preoperative bevacizumab injection at baseline and overa 6-month period after vitrectomy.

Reference

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