Intravitreal Bevacizumab and Panretinal Photocoagulation for Proliferative Diabetic Retinopathy Associated With Vitreous Hemorrhage

Huang, Yu-Hsun; Yeh, Po-Ting; Chen, Muh‐Shy; Yang, Chang-Hao; Yang, Chung-May

doi:10.1097/iae.0b013e3181b094b7

Cited by 57 publications

(47 citation statements)

References 26 publications

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“…In addition, many trials mentioned the prior PRP in the material and methods, but no details of any previous laser treatment were shown in the results. 33,34 IVB injection, nevertheless, seems to be a promising treatment for active PDR with previous adequate PRP. The most comparable study to ours was conducted by Jorge et al 29 who assessed IVB in persistent leaking NV, unresponsive to complete PRP, performed at least four months.…”

Section: Discussionmentioning

confidence: 99%

Intravitreal bevacizumab for proliferative diabetic retinopathy with new dense vitreous hemorrhage after full panretinal photocoagulation

Sinawat

Rattanapakorn

Sanguansak

et al. 2013

Eye

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Purpose To evaluate the efficacy and safety of intravitreal bevacizumab (IVB) injections for the treatment of proliferative diabetic retinopathy (PDR) with new dense vitreous hemorrhage (VH) after previous full panretinal photocoagulation (PRP). Methods Prospective study of consecutive PDR with prior complete PRP patients, who presented with new dense VH, were treated with IVB injection. Complete ophthalmic examination and/or ocular ultrasonography were performed at baseline and 1, 6, and 12 weeks and 6, 9, and 12 months after the first injection. Reinjection was done in non-clearing and recurrent VH. Results Eighteen eyes of 18 patients, mean age 47.7±12.69 years were included. In all, 14 (77.78%) patients had type 2 diabetes mellitus. Systemic hypertension and dyslipidemia were the most common systemic diseases. All cases were phakic eye with previous complete PRP. Patients received 1.6±0.42 intravitreal injections over a 12-month period. VH cleared completely in 7 (38.89%), 9 (50%), and 13 (72.22%) eyes after 6 weeks, 6 months, and 12 months, respectively. Re-bleeding, however, occurred in 10 (56%) eyes during the follow-up period, and 5 (28%) eyes still had residual VH at the last visit. Statistically significant visual gain was observed in 9 (50%) eyes. Unfortunately, 2 (11%) eyes had severe visual loss because of the tractional retinal detachment (TRD). Mild ocular complication was detected in one patient.Conclusion IVB injection had good efficacy and safety for treatment of new VH in patients with PDR and prior complete PRP. This procedure may be especially relevant for diabetic patients at high-risk for surgical intervention.

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Section: Discussionmentioning

confidence: 99%

Intravitreal bevacizumab for proliferative diabetic retinopathy with new dense vitreous hemorrhage after full panretinal photocoagulation

Sinawat

Rattanapakorn

Sanguansak

et al. 2013

Eye

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“…In literature, the progression to TRD from a preexisting fibrovascular tissue contraction is a risk in few cases after intravitreal bevacizumab. 10,20,22 Furthermore, Arevalo et al reported the development or progression of TRD in 5.2% patients with severe PDR following intravitreal bevacizumab. 23 Cautious echographic examinations should be done before intravitreal bevacizumab to exclude the patients with broad vitreoretinal adhesion.…”

Section: Figmentioning

confidence: 99%

Intravitreal Bevacizumab (Avastin) and Panretinal Photocoagulation in the Treatment of High-Risk Proliferative Diabetic Retinopathy

Yang

Hung

Huang

et al. 2013

Journal of Ocular Pharmacology and Therapeutics

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Purpose: To report the short-term efficacy and safety of intravitreal bevacizumab (Avastin) injection with panretinal laser photocoagulation (PRP) in patients with high-risk proliferative diabetic retinopathy (PDR) according to the Early Treatment Diabetic Retinopathy Study criteria. Methods: A prospective, interventional case series study was conducted in 17 patients (20 eyes) with high-risk PDR, who were treated with intravitreal bevacizumab (2.5 mg) followed by PRP when the peripheral vitreous became clear or 2 weeks after injection. Patients underwent complete ophthalmic evaluation, including Snellen visual acuity and fluorescein angiography at baseline, 1, 3, and 6 months after bevacizumab injection. Main outcome measures included the serial changes in visual acuity, vitreous clear-up time, and neovascularization on the disc (NVD) regression time. Results: All patients had obvious reduction in angiographic leakage and involution of retinal neovascularization (NV) at the 1-and 3-month follow-up. The mean follow-up time was 7.5 months. The vitreous hemorrhage (VH) showed a partial resolution as early as 1 week, and complete regression at 3 months. The mean vitreous clear-up time after intravitreal Avastin was 8.5 -2.2 weeks. The mean time interval from intravitreal Avastin to NVD regression was 10.8 -3.4 weeks. Mean logarithm of the minimum angle resolution visual acuity improved from 1.03 at baseline to 0.36 at 1-month, 0.38 at 3-month, and 0.48 at the 6-month follow-up (P < 0.01). Three eyes (18%) required vitrectomy surgery during follow-up. The indication for vitrectomy was dense, persistent VH in 2 eyes, and focal tractional retinal detachment (TRD) in 1 eye. Recurrent retinal NV with minor preretinal hemorrhage was observed in 6 eyes (30%) 3 months after the first injection, and resolved after repeated bevacizumab injections. Patients received an average of 1.4 injections (range: 1-2). Seven eyes (35%) underwent 2 injections. One eye (5%) had ocular complication of PDR progression to TRD. No systemic adverse events were observed following injections. Conclusions: Short-term results suggest combined intravitreal bevacizumab and PRP achieved rapid clearance of VH, regression of retinal NV, and visual improvement in the treatment of high-risk PDR. Long-term study is warranted to assess the long-term efficacy and safety.

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“…Anti-VEGF agents reduce the time required for vitreous clear-up and decrease the need for vitrectomy. 77,78 In most cases, bevacizumab was injected 1 week before the vitrectomy in order to avoid TRD in cases of severe PDR as discussed above. 37,45 In a recent study by the Diabetic Retinopathy Clinical Research Network, the benefit of intravitreal ranibizumab was compared with intravitreal saline injections on vitrectomy rates for vitreous haemorrhage from PDR.…”

Section: Indications Of Anti-vegf Treatment For Pdrmentioning

confidence: 99%

A review of anti-VEGF agents for proliferative diabetic retinopathy

Osaadon

Fagan

Lifshitz

et al. 2014

Eye

224

148

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Intravitreal Bevacizumab and Panretinal Photocoagulation for Proliferative Diabetic Retinopathy Associated With Vitreous Hemorrhage

Abstract: One or 2 intravitreal injections of 1.25 mg bevacizumab with PRP are associated with rapid regression of VH and may reduce the need for vitrectomy.

Cited by 57 publications

References 26 publications

Intravitreal bevacizumab for proliferative diabetic retinopathy with new dense vitreous hemorrhage after full panretinal photocoagulation

Intravitreal bevacizumab for proliferative diabetic retinopathy with new dense vitreous hemorrhage after full panretinal photocoagulation

Intravitreal Bevacizumab (Avastin) and Panretinal Photocoagulation in the Treatment of High-Risk Proliferative Diabetic Retinopathy

A review of anti-VEGF agents for proliferative diabetic retinopathy

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