Abstract
Aims
To evaluate the recurrence rate of vitreous haemorrhage (VH) in patients treated with one intravitreal bevacizumab (IVB) injection (2.5 mg/0.1 ml) before planned pars plana vitrectomy for treatment of diabetic non-clearing VH.
Methods
Prospective pilot study of 32 eyes of 31 consecutive diabetic patients who underwent IVB injection within 1 week before surgery for persistent VH in the presence of active proliferative diabetic retinopathy. Three masked retinal specialists graded the amount of VH from grade 0 to grade 3 with slit-lamp biomicroscopy. Main outcome measures were the rate of recurrence of the VH, improvement in visual acuity, incidence of cataract formation, and postoperative complications through a follow-up of 6 months.
Results
The percentage of severe recurrent VH with no fundus details (grade 3) was 3% at 1 week follow-up and 3, 6, and 6% respectively at 1-, 3-, and 6-month follow-up. The mean best-corrected visual acuity (BCVA) improved from 1.6 (1/60) to 0.40 (6/15) logMAR (P=0.02) in 29 out of 32 eyes (91%). In all, 12 out of 22 (54%) phakic eyes developed cataract during the follow-up period, and 10 (31%) of them underwent cataract surgery.
Conclusions
Our study suggests that IVB injection few days before planned surgery seems to be efficacious and safe as an adjuvant treatment to prevent rebleeding in eyes undergoing pars plana vitrectomy for treatment of diabetic vitreous haemorrhage. IVB facilitates the surgery and reduces the need for extensive delamination and segmentation, decreasing the possibility of significant early active postoperative VH.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Novak MA, Rice TA, Michels RG, Auer C . Vitreous hemorrhage after vitrectomy for diabetic retinopathy. Ophthalmology 1984; 91: 1485–1489.
Avery RL, Pearlman J, Pieramici DJ, Rabena MD, Castellarin AA, Nasir MA et al. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology 2006; 113: 1695.e1–1695.e15.
Landers MB, Perraki AD . Management of post-vitrectomy persistent vitreous hemorrhage in pseudophakic eyes. Am J Ophthalmol 2003; 136: 989–993.
Yang CM, Yeh PT, Yang CH . Intravitreal long-acting gas in the prevention of early postoperative vitreous hemorrhage in diabetic vitrectomy. Ophthalmology 2007; 114: 710–715.
Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 1994; 331: 1480–1487.
Spaide RF, Fisher YL . Intravitreal bevacizumab (Avastin) treatment of proliferative diabetic retinopathy complicated by vitreous hemorrhage. Retina 2006; 26: 275–278.
Rizzo S, Genovesi-Ebert F, Di Bartolo E, Vento A, Miniaci S, Williams G . Injection of intravitreal bevacizumab (Avastin) as a preoperative adjunct before vitrectomy surgery in the treatment of severe proliferative diabetic retinopathy (PDR). Graefes Arch Clin Exp Ophthalmol 2008; 246: 837–842.
Yang CM, Yeh PT, Yang CH, Chen MS . Bevacizumab pretreatment and long-acting gas infusion on vitreous clear-up after diabetic vitrectomy. Am J Ophthalmol 2008; 146: 211–217.
West JF, Gregor ZJ . Fibrovascular ingrowth and recurrent haemorrhage following diabetic vitrectomy. Br J Ophthalmol 2000; 84: 822–825.
Comer GM, Ciulla TA . Pharmacotherapy for diabetic retinopathy. Curr Opin Ophthalmol 2008; 15: 508–518.
Warner T . Relationships between the endothelin and nitric oxide pathways. Clin Exp Pharmacol Physiol 1999; 26: 247–252.
Kent D, Sheridan C . Choroidal neovascularization: a wound healing perspective. Mol Vis 2003; 9: 747–755.
Author information
Authors and Affiliations
Corresponding author
Additional information
Financial/proprietary interest: None
Rights and permissions
About this article
Cite this article
Romano, M., Gibran, S., Marticorena, J. et al. Can a preoperative bevacizumab injection prevent recurrent postvitrectomy diabetic vitreous haemorrhage?. Eye 23, 1698–1701 (2009). https://doi.org/10.1038/eye.2008.354
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2008.354
Keywords
This article is cited by
-
Twenty-seven-gauge vitrectomy for combined tractional and rhegmatogenous retinal detachment involving the macula associated with proliferative diabetic retinopathy
International Journal of Retina and Vitreous (2017)
-
Ranibizumab pretreatment in diabetic vitrectomy: a pilot randomised controlled trial (the RaDiVit study)
Eye (2017)
-
Effect of Intravitreal Anti-VEGF Therapy on the Severity of Diabetic Retinopathy
Current Ophthalmology Reports (2016)
-
Six-month visual outcome after pars plana vitrectomy in proliferative diabetic retinopathy with or without a single preoperative injection of intravitreal bevacizumab
International Ophthalmology (2012)
-
Bevacizumab prior to vitrectomy for diabetic traction retinal detachment
Eye (2011)
