Use of pegaptanib for recurrent and non-clearing vitreous haemorrhage in proliferative diabetic retinopathy.
OBJECTIVE
Diabetes is the leading cause of blindness in the United Kingdom among people of working age. Many with proliferative diabetic retinopathy (PDR) go on to develop vitreous haemorrhage (VH). Those with recurrent or non-clearing VH require vitrectomy to restore vision. Pegaptanib is a vascular endothelial growth factor antagonist that disrupts the proliferative cascade and has been shown to precipitate regression of retinal neovascularisation. We assessed the effect of pre-operative intravitreal (IVT) pegaptanib on the timing, difficulty, and outcome of vitrectomy for recurrent VH in PDR.


METHODS
Fourteen consecutive patients (15 eyes) were given a course of 1-3 IVT pegaptanib injections and vitrectomy was performed when indicated by the recurrence or persistence of VH, or progression of associated tractional retinal detachment (TRD).


RESULTS
The range of patient follow-up was from 6 months to 2 years. All had no further VH for at least 4 weeks after IVT pegaptanib. Five eyes remained free from VH until the end of the study (8-25 months), thus obviating the need for vitrectomy. Two further cases avoided vitrectomy following further IVT pegaptanib. In the majority of patients with VH, IVT pegaptanib created a window for further laser and risk factor optimisation. Surgery was faster and less challenging, compared with conventional vitrectomy for recurrent VH due to PDR.


CONCLUSIONS
IVT pegaptanib can be considered in diabetic patients with VH. Approximately one-third may avoid vitrectomy altogether. There are clear intra-operative advantages of using IVT pegaptanib pre-operatively. However, caution should be exercised where there is pre-existing TRD.
Ophthalmology Department, St Mary's Hospital, Isle of Wight, Newport, Hants, UK. dan.hornan@googlemail.com
D
D
Hornan
N
N
Edmeades
R
R
Krishnan
J
J
Khan
J
J
Lochhead
D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D052157:Aptamers, Nucleotide / Q000627:therapeutic use*; D003930:Diabetic Retinopathy / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D012008:Recurrence; D014792:Visual Acuity; D014823:Vitreous Hemorrhage / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery
D020533:Angiogenesis Inhibitors; D052157:Aptamers, Nucleotide; C495058:pegaptanib