Intraoperative bleeding during vitrectomy for diabetic tractional retinal detachment with versus without preoperative intravitreal bevacizumab (IBeTra study)

Abstract

NCT00690768.

Surgical management of the late complications of proliferative diabetic retinopathy

“…Intravitreal bevacizumab administered 1-2 weeks pre-operatively has been reported to facilitate surgical dissection of fibrovascular membranes in eyes with severe active PDR. 35,36,[65][66][67] The risk of recurrent vitreous cavity haemorrhage may also be reduced by this treatment. 34 However, there is a potential adverse effect because fibrovascular membrane contraction can lead to rapid development or progression of tractional retinal detachment.…”

“…32,33 More recently, intravitreal anti-VEGF therapy with bevacizumab administered 1-2 weeks pre-operatively has been reported to provide some benefit. [34][35][36] Early vitreous cavity haemorrhages usually clear spontaneously within 2-6 weeks without requiring further intervention.…”

Bevacizumab prior to vitrectomy for diabetic traction retinal detachment

“…This vascular endothelial growth factor inhibitor has been reported to decrease intraoperative hemorrhage and facilitate fibrovascular membrane dissection, [3][4][5][6][7][8][9][10][11][12] and reduce postoperative vitreous hemorrhage (VH) rates. 9,[12][13][14] However, these studies were limited by relatively small numbers, heterogeneous retinal pathology (TRD and VH were studied together), and varying surgical techniques (multiple surgeons and multiple gauge vitrectomies).…”

Antiangiogenic drugs and advanced proliferative diabetic retinopathy

“…This time is considered to be safe in order to avoid complications of increased fibrosis and vitreoretinal traction, with regression of active neovessels and reduction of high VEGF levels characteristic of PDR having been observed (33) . The preoperative use of bevacizumab proved to be favorable regarding technical aspects of the execution of pars plana vitrectomy, reducing surgical time and material exchange and facilitating the removal of fibrovascular membranes, in addition to reducing intraoperative hemorrhage and the need to use endodiathermy (3,20,(22)(23)25,27,(29)(30) . The improvement of the surgical technique for vitrectomy was probably due to the induction of neovascular regression and the reduction of vascular caliber (3,(6)(7)22,25,30) , with the consequent facilitation of the intraoperative manipulation of fibrovascular proliferations.…”

“…Bevacizumab has been used preoperatively as an adjuvant in vitrectomy in patients with TRD, vitreal hemorrhage, mixed TRD, active fibrovascular proliferation (FVP) (3,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) , and neovascular glaucoma (31) (Table 1). Also, a pilot study of bevacizumab injected immediately after vitrectomy for vitreous hemorrhage was conducted (32) .…”