Intravitreal bevacizumab for surgical treatment of severe proliferative diabetic retinopathy

Lauro, R. Di; Ruggiero, Pio De; Lauro, Raffaella di; Lauro, Maria Teresa di; Romano, Mario R.

doi:10.1007/s00417-010-1303-3

Cited by 93 publications

(84 citation statements)

References 53 publications

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“…This non-significant finding mirrors the reductions in intraoperative bleeding reported in other studies. 7,10 Patients in Africa commonly present late with advanced disease. 2 Africans have also been noted to form more extensive FVMs than those found in Caucasian populations.…”

Section: Discussionmentioning

confidence: 99%

“…Injections were given at 2-4 days before operating; this is now considered to be the optimum time to give IVB, as it provides time for vascular regression, but is not enough to allow the development or progression of TRD. 7 The IVB group had a reduced rate of significant intraoperative haemorrhages, six in the non-IVB group and one in the IVB group (P ¼ 0.24). This non-significant finding mirrors the reductions in intraoperative bleeding reported in other studies.…”

Section: Discussionmentioning

confidence: 99%

“…6 IVB has also been shown to decrease intraoperative haemorrhage. 7,8 This study investigated the outcomes of diabetic vitrectomy surgery in the Kilimanjaro Christian Medical Centre Eye Department in Tanzania, East Africa, before and after the introduction of previtrectomy IVB use. It is the first to examine the effectiveness of preoperative IVB in the region.…”

Section: Introductionmentioning

confidence: 99%

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Bevacizumab as an adjunct to vitreoretinal surgery for diabetic retinopathy in East Africa

Guthrie

Hall

Dhalla

et al. 2013

Eye

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Purpose 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)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(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 ¼ 0.24). Silicon oil was used in 29 (48%) non-IVB eyes and in 11 (27%) IVB eyes (P ¼ 0.03). The non-IVB eyes underwent significantly more vitreoretinal reoperations (P ¼ 0.01) and were significantly more likely to lose two or more lines of vision at the final follow-up (P ¼ 0.03). The numbers needed to treat (NNT) blindness (o3/60) 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 (Z3/60) 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bevacizumab as an adjunct to vitreoretinal surgery for diabetic retinopathy in East Africa

Guthrie

Hall

Dhalla

et al. 2013

Eye

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“…IVB causes regression of neovascularization which decreases intraoperative bleeding and facilitates membrane peeling and delamination. 12 Second, younger patients tend to have less macular ischemia and therefore more visual potential. And third, the lenses of younger patients are less prone to develop postvitrectomy cataracts.…”

Section: Discussionmentioning

confidence: 99%

“…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). Concern still exists that IVB may worsen TRD, 6,[15][16][17] and may cause the foveal vascular zone enlargement.…”

Section: Introductionmentioning

confidence: 99%

Bevacizumab prior to vitrectomy for diabetic traction retinal detachment

Pokroy

Desai

et al. 2011

Eye

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Angiofibrotic Response to Vascular Endothelial Growth Factor Inhibition in Diabetic Retinal Detachment

Sohn¹,

He²,

Kim³

et al. 2012

Arch Ophthalmol

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Purpose To assess the effect of bevacizumab on connective tissue growth factor (CTGF) and VEGF in ocular fluids of patients with diabetic traction retinal detachment. To determine whether intra- and post-operative complications are decreased in eyes given adjunctive pre-operative bevacizumab. Methods Twenty eyes of 19 patients were randomized to receive intravitreal bevacizumab or sham 3–7 days prior to vitrectomy for severe proliferative diabetic retinopathy. Aqueous samples prior to injection and at time of surgery were collected. Undiluted vitreous samples were extracted. Results Five eyes had decreased vascularization of membranes from pre-injection to time of surgery (all in treatment arm). Median visual acuity was 20/400 in controls at baseline and 3 months post-op; counts fingers in the treated group at baseline and 20/100 at 3 months (p=0.30 between controls and treated at 3 months). All retinas were attached at post-operative month 3. Vitreous levels of VEGF were significantly lower in the bevacizumab group than the control group (p-value=0.03). Vitreous levels of CTGF were slightly lower in the bevacizumab group compared to controls but this was not statistically significant (p-value=0.38). CTGF levels in the aqueous were strongly correlated to those in the vitreous of controls (Spearman correlation coefficient 0.95, p-value<0.001). Conclusions Intravitreal bevacizumab reduces vitreous levels of VEGF and produces a clinically observable alteration in diabetic fibrovascular membranes. Ocular fluid levels of CTGF are not significantly affected within the week following VEGF inhibition. Retinal reattachment rates and visual acuity are not significantly altered by pre-operative intravitreal bevacizumab at post-operative month 3.

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Intravitreal bevacizumab for surgical treatment of severe proliferative diabetic retinopathy

Cited by 93 publications

References 53 publications

Bevacizumab as an adjunct to vitreoretinal surgery for diabetic retinopathy in East Africa

Bevacizumab as an adjunct to vitreoretinal surgery for diabetic retinopathy in East Africa

Bevacizumab prior to vitrectomy for diabetic traction retinal detachment

Angiofibrotic Response to Vascular Endothelial Growth Factor Inhibition in Diabetic Retinal Detachment

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