title: Early vitreous hemorrhage after vitrectomy with preoperative intravitreal bevacizumab for proliferative diabetic retinopathy.
abstract: OBJECTIVE
  To evaluate the effect of preoperative intravitreal bevacizumab (IVB) on surgical procedures, visual prognosis, and postoperative complications, especially postoperative vitreous hemorrhage, in cases with proliferative diabetic retinopathy (PDR).
  
  
  METHODS
  Seventy-one eyes of 54 consecutive patients (23 eyes of 18 women, 48 eyes of 36 men) were investigated in this study. Twenty-five eyes received IVB one to 30 days before the vitrectomy (Bevacizumab Group) and the other 46 eyes had the vitrectomy alone (Control Group). The surgical procedures, best-corrected visual acuities at baseline, 1, 3, and 6 months after the vitrectomy, and postoperative complications in the Bevacizumab Group were compared to the Control Group.
  
  
  RESULTS
  The patients were significantly younger in the Bevacizumab Group compared to the Control Group (P = 0.008). The incidence of preoperative vitreous hemorrhage, tractional retinal detachment, and iris neovascularization was significantly higher in the Bevacizumab Group than in the Control Group (P = 0.017, 0.041, and 0.018, respectively). The surgical procedures performed and the visual acuity at all time points was not significantly different between groups (P > 0.05, all comparisons). The incidence of early (≤ 4 weeks) postoperative vitreous hemorrhage was significantly higher in the Bevacizumab Group (27%) than in the Control Group (7%; P = 0.027) although the rate of late (>4 weeks) postoperative vitreous hemorrhage was not significantly different between groups (P > 0.05).
  
  
  CONCLUSIONS
  Vitrectomy with preoperative IVB may have no detrimental effect on surgical procedures and achieves the surgical outcomes for repair of PDR equal to vitrectomy alone despite the obvious selection bias of the patients in this study. However, special monitoring is highly recommended for early postoperative vitreous hemorrhage because bevacizumab in the vitreous may be washed out during vitrectomy.
authors.affiliation: Osaka Rosai Hospital, Clinical Research Center for Occupational Sensory Organ Disability, Kita-Ku, Sakai, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Sato
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Morita
authors.forename: Hajime
authors.initials: H
authors.lastname: Bando
authors.forename: Shigeru
authors.initials: S
authors.lastname: Sato
authors.forename: Toshihide
authors.initials: T
authors.lastname: Ikeda
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Emi
mesh_terms: D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D003131:Combined Modality Therapy; D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D058449:Intravitreal Injections; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity; D014821:Vitrectomy; D014823:Vitreous Hemorrhage / Q000209:etiology*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab
keywords: Bevacizumab; Postoperative Vitreous Haemorrhage; Proliferative Diabetic Retinopathy; Vascular Endothelial Growth Factor; Vitrectomy