Anti-Vascular Endothelial Growth Factor Therapy as an Adjunct to Diabetic Vitrectomy

Abstract

Introduction: The purpose of this work is to study the efficacy of the preoperative intravitreal administration of bevacizumab as an adjunct to vitrectomy in patients with Proliferative Diabetic Retinopathy (PDR). Methods: This retrospective comparative study was performed on 118 eyes (118 patients) with proliferative diabetic retinopathy (PDR), which underwent vitrectomy surgery at the Department of Diabetic Eye Disease at Zarifa Aliyeva National Ophthalmology Centre (Baku, Azerbaijan) in 2015-2019. The main group (the bevacizumab group) included 48 eyes with PDR that received intravitreal administration of bevacizumab (Avastin; Genentech Inc., USA) within one week before vitrectomy; the control group included 70 eyes that did not receive a bevacizumab injection for at least 3 months before the vitrectomy. The minimum follow-up was 12 months. Results: In both groups, complete retinal attachment after primary vitrectomy was achieved in all eyes (100%). Clinically significant intraoperative haemorrhage was observed in the preoperative bevacizumab injection group in 31.2% and the control group- 51.4%, p = 0.030. The preoperative bevacizumab injection reduced the risk of clinically significant haemorrhage by 2.3 times and the need for endodiathermy by 2.7 times (p = 0.031 and p = 0.024, respectively). Early vitreous cavity haemorrhage was observed in 15.0% in the bevacizumab group and in 35.5% in the control group (p = 0.038). The preoperative injection of bevacizumab before vitrectomy reduced the risk of vitreous cavity haemorrhage in the early postoperative period by 3.0 times (p = 0.036). Conclusion: The preoperative use of bevacizumab as an adjunct to diabetic vitrectomy can help reduce the incidence of intraoperative and early postoperative vitreous cavity haemorrhage, which leads to better functional results in the early postoperative period. Over the long-term follow-up period, the effect of the preoperative bevacizumab injections decreases.

Postoperative Bleed after PARS Plana Vitrectomy with Pre-Operative Intra Vitreal Bevacizumab in Diabetic Patients with Advance Diabetic Eye Disease

“…[14][15][16][17][18][19] In a related study, Rizzo et al found that among patients with advanced diabetic retinopathy who received intravitreal Bevacizumab (Avastin) injections, there was no or minimal bleeding in 54% of cases, mild to moderate bleeding in 27%, and severe bleeding in 18% of patients undergoing pars plana vitrectomy. 7 Nagpal M et al also reported 56.6% patients with no or minimal post operative bleeding, 22 % of the patients with mild to moderate vitreous cavity hemorrhage and 22 % with severe vitreous cavity hemorrhage in patients with advance diabetic eye disease who received pre-operative intravitrealBevacizumab (Avastin). 22,13,18 Studies have shown that with the use of bevacizumab intravitrealy in patients with advance diabetic eye disease pre operatively, we can reduce the risk of iatrogenic retinal breaks during surgery and can reduce complications from this procedure.…”

“…22,13,18 Studies have shown that with the use of bevacizumab intravitrealy in patients with advance diabetic eye disease pre operatively, we can reduce the risk of iatrogenic retinal breaks during surgery and can reduce complications from this procedure. 14,7…”

“…These neo vessels are friable , easy to bleed and are leaky blood vessels due to abnormal basement membrane development in these patients in response to metabolic derangements caused by persistent long term hyperglycemia. 7,8 Patients with advanced diabetic eye disease who underwent 23 gauge three ports pars plana vitrectomy for tractional retinal detachment and received a preoperative intravitreal inj. of Bevacizumab seven days before surgery had no bleeding in 60.7%, mild bleeding in 21.2%, and excessive bleeding requiring diathermy per operatively in only 17.9% but this study had limited generalization as its sample size was low and there is also due to variation among surgical techniques between different surgeons and case to case variation .…”