title: [Use of bevacizumab in the treatment of complicated proliferative diabetic retinopathy].
abstract: BACKGROUND
  Diabetes is the leading cause of neovascular vitreoretinal proliferation. Several recent publications have appeared showing the efficacy and safety of intravitreal bevacizumab (IVT) in proliferative or complicated diabetic retinopathy (PDR), but with no consensus on the injected dose. We report the results of its use as adjuvant intravitreal injection (IVT) prior to posterior vitrectomy in the setting of complicated PDR. The goal of our work is to evaluate the benefits of and try to establish a protocol for proper use of intravitreal bevacizumab prior to vitrectomy for complicated PDR, so as to incorporate it in the management of this disease.
  
  
  METHODS
  A prospective comparative study of series of patients hospitalized for severe complicated PDR requiring vitrectomy was spread over one year, from January 2011 to December 2011. Included patients were divided into two groups: group A: receiving an injection preoperatively at a dose of 1.25mg, and group B, which received an injection of bevacizumab at a dose of 0.75mg (with a time to surgery of either less than 3 days, more than 6, or 3 to 6). We analyzed the epidemiological characteristics, data from the initial eye examination and intraoperative complications and follow-up after vitrectomy.
  
  
  RESULTS
  Thirty-five patients were included. We noted no significant difference in epidemiological characteristics between group A and B. Sixty percent of patients underwent surgery after a period of three to six days post-IVT. The reduction of neovascularization, decreased risk of bleeding and the facilitation of membrane peeling during surgery were significantly similar between group A and B. No complication related to the molecule and no recurrence, including bleeding, were noted throughout follow-up in both groups.
  
  
  CONCLUSIONS
  We opt for a systematic use of anti-VEGF, particularly bevacizumab prior to all vitrectomies for complicated PDR. A 0.75mg dose at an interval of 3 to 6 days seems to be a good compromise between the desired effect and possible complications that may arise.
authors.affiliation: Service d'ophtalmologie adulte, hôpital 20-Août, CHU Ibn Rochd, 1, rue des Hôpitaux, 20500 Casablanca, Maroc. Electronic address: lbenhmidoune@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Benhmidoune
authors.forename: A
authors.initials: A
authors.lastname: McHachi
authors.forename: M
authors.initials: M
authors.lastname: Boukhrissa
authors.forename: A
authors.initials: A
authors.lastname: Chakib
authors.forename: R
authors.initials: R
authors.lastname: Rachid
authors.forename: M
authors.initials: M
authors.lastname: Elbelhadji
authors.forename: A
authors.initials: A
authors.lastname: Amraoui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D003131:Combined Modality Therapy; D003930:Diabetic Retinopathy / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D014821:Vitrectomy; D018630:Vitreoretinopathy, Proliferative / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab
keywords: Bevacizumab; Bévacizumab; Décollement de rétine tractionnel; Fibrovascular proliferation; Injection intravitréenne; Intravitreal injection; Proliferative diabetic retinopathy; Prolifération fibrovasculaire; Rétinopathie diabétique proliférante; Tractional retinal detachment; Vitrectomie; Vitrectomy