title: Role of intravitreal bevacizumab in Eales disease with dense vitreous hemorrhage: a prospective randomized control study.
abstract: OBJECTIVE
  To investigate the role of intravitreal bevacizumab in Eales disease with dense vitreous hemorrhage.
  
  
  METHODS
  This is a prospective randomized control trial. Twenty eyes of 20 patients with dense vitreous hemorrhage because of Eales disease were randomly distributed in Group 1 (n = 10) and Group 2 (n = 10). Group 1 eyes received intravitreal injection of bevacizumab (1.25 mg/0.05 mL) every 4 weeks, and Group 2 eyes were observed. Patients of both groups were followed-up every 2 weeks. Vitrectomy was performed in case of nonresolving vitreous hemorrhage Grade 2 or more after 3 months of enrollment or immediately if retinal detachment was detected. Intraoperative difficulties while performing surgery and excessive bleeding were noted. The primary outcome measures were reduction in the grade of vitreous hemorrhage and the need for vitrectomy.
  
  
  RESULTS
  Only 1 eye from Group 1 and 2 eyes from Group 2 showed decrease in vitreous hemorrhage to Grade 2 (P = 0.531, 95% confidence interval). But all three eyes required vitrectomy because of persisting poor vision. Postoperative mean vision ± SD in Group 1 was 1.2 ± 0.57 in logarithm of the minimum angle of resolution units, and in Group 2, it was 0.78 ± 0.41 in logarithm of the minimum angle of resolution units (P = 0.086, 95% confidence interval). Three eyes (30%) in Group 1 had tractional retinal detachment after a single bevacizumab injection, while none of the Group 2 eyes had tractional retinal detachment (P = 0.060, 95% confidence interval). Vitrectomy was performed in all three eyes and had poor visual outcome after surgery. No intraoperative difficulties were noted in either group.
  
  
  CONCLUSIONS
  Our study showed that repeated intravitreal bevacizumab in patients with Eales disease with dense vitreous hemorrhage may not hasten the resolution of vitreous hemorrhage or reduce the need for vitrectomy. Moreover, tractional retinal detachment may be a serious complication of therapy and hence should be closely monitored because it entails a poor visual prognosis.
authors.affiliation: Vitreo - Retina Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. patwardhan.sourabh@gmail.com
authors.forename: Sourabh Dileep
authors.initials: SD
authors.lastname: Patwardhan
authors.forename: Rajvardhan
authors.initials: R
authors.lastname: Azad
authors.forename: Bhavin Mahendra
authors.initials: BM
authors.lastname: Shah
authors.forename: Yograj
authors.initials: Y
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D031300:Retinal Vasculitis / Q000188:drug therapy* / Q000503:physiopathology; D019233:Retreatment; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D014823:Vitreous Hemorrhage / Q000188:drug therapy* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab