Bevacizumab as an adjunct to vitreoretinal surgery for diabetic retinopathy in East Africa.
OBJECTIVE
The purpose of this study is to evaluate the efficacy of preoperative intravitreal bevacizumab (IVB) for improving outcomes in vitrectomy for diabetic retinopathy-related non-clearing vitreous haemorrhage and/or tractional retinal detachment.


METHODS
Medical record from patients undergoing vitrectomy for proliferative diabetic retinopathy (PDR) were retrospectively analysed (2003-2011). From 2007, IVB (1.25 mg 2-4 days before operating) was used on all eyes. Eyes receiving IVB were compared with those that did not receive IVB. Intraoperative complications, reoperation rates, and final visual acuity were the core outcome measures.


RESULTS
Data were analysed for 88 patients (101 eyes). In all, 41 (41%) patients had received IVB, whereas 60 (59%) patients had not. Significant intraoperative haemorrhage occurred in six eyes (10%) in the non-IVB group and in one (2.4%) IVB eyes (P=0.24). Silicon oil was used in 29 (48%) non-IVB eyes and in 11 (27%) IVB eyes (P=0.03). The non-IVB eyes underwent significantly more vitreoretinal reoperations (P=0.01) and were significantly more likely to lose two or more lines of vision at the final follow-up (P=0.03). The numbers needed to treat (NNT) blindness (<3/60) was four for non-IVB eyes and two for the IVB group.


CONCLUSIONS
IVB reduces surgical complications, the use of silicon oil, and the need for further retinal surgery. The NNT to restore useful vision (≥3/60) to a blind eye were significantly lower in the IVB group. Vitreoretinal surgery for the complications of PDR is effective in an East African context, and IVB should be considered a valuable adjunct.
1] Newcastle University Medical School, Newcastle Upon Tyne, UK [2] Institute of Genetic Medicine, Newcastle Upon Tyne, UK [3] Eye Department, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
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Guthrie
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Hall
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Dhalla
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Davies
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Davis
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Steel
D000328:Adult; D000351:Africa, Eastern; D000368:Aged; D000704:Analysis of Variance; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003930:Diabetic Retinopathy / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012086:Reoperation / Q000706:statistics & numerical data; D012163:Retinal Detachment / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D014792:Visual Acuity; D057586:Vitreoretinal Surgery / Q000379:methods*; D014823:Vitreous Hemorrhage / Q000209:etiology / Q000628:therapy*; D055815:Young Adult
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab