Experience with intravitreal bevacizumab as a preoperative adjunct in 23-G vitrectomy for advanced proliferative diabetic retinopathy.
OBJECTIVE
To evaluate the safety and efficacy of intravitreal injection of bevacizumab before vitrectomy in advanced proliferative diabetic retinopathy.


METHODS
A randomized clinical trial was performed on 40 eyes of 40 patients. Inclusion criteria were advanced proliferative diabetic retinopathy with tractional retinal detachment and HbA1c <7%. Patients were randomly assigned into 2 groups. Patients in one group had an intravitreal injection (1.25 mg) of bevacizumab 48 hours before 23-G pars plana vitrectomy surgery was performed, whereas the other group did not. Best-corrected visual acuity, intraocular pressure, and fundus photographs were taken prior to surgery 1 week and 3 and 6 months postoperatively.


RESULTS
Effective vitrectomy time was 8.05 minutes in the bevacizumab group vs 16.8 minutes in the non-bevacizumab group. Statistically significant differences were observed in visual acuity at 1 week and 3 and 6 months follow-up between the 2 groups (p<0.05 for each visit). Also, there was less bleeding intraoperatively in the bevacizumab group. Mean final visual acuity in the bevacizumab group was 0.82 logMAR and 2.01 logMAR in the non-bevacizumab group.


CONCLUSIONS
Adjuvant intravitreal injection of bevacizumab prior to vitrectomy in diabetic retinopathy with tractional retinal detachment significantly eases the procedure, diminishing intraoperative complications, and leads to a better visual outcome.
Hernández-Da Mota
Sergio E
SE
Ophthalmology Department, General Hospital Dr. Miguel Silva, and Retina Department, Clínica David-Unidad Oftalmológica, Blvd. García de León 598, Colonia Nueva Chapultepec, Morelia, Michoacán, México. tolodamota@yahoo.com.mx
Nuñez-Solorio
Silvia M
SM
D020533:Angiogenesis Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D017024:Chemotherapy, Adjuvant; D003930:Diabetic Retinopathy / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007431:Intraoperative Complications / Q000517:prevention & control; D058449:Intravitreal Injections; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D057234:Preoperative Period; D012163:Retinal Detachment / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D006442:Glycated Hemoglobin; D042461:Vascular Endothelial Growth Factor A; C467484:VEGFA protein, human; C517652:hemoglobin A1c protein, human