Intravitreal injection of bevacizumab in primary vitrectomy to decrease the rate of retinal redetachment: A randomized pilot study

Tousi, Adib; Hasanpour, Hossein; Soheilian, Masoud

doi:10.4103/2008-322x.188390

Cited by 15 publications

(7 citation statements)

References 30 publications

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“…There is a paucity of studies investigating the effect of intravitreal bevacizumab as a surgical adjunct for the prevention of PVR after RRD surgery [15][16][17]27]. All failed to demonstrate any clinical benefit, but they only considered eyes with advanced stages of PVR [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Intravitreal Injection of Bevacizumab for the Prevention of Postoperative Proliferative Vitreoretinopathy in High-Risk Patients Selected by Laser Flare Photometry

Gahon,

Luc,

Zessler

et al. 2023

Ophthalmologica

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Introduction: To evaluate the effect of an intravitreal injection of bevacizumab at the time of rhegmatogenous retinal detachment (RRD) surgery, on postoperative proliferative vitreoretinopathy (PVR) in high-risk patients selected by laser flare photometry. Methods: This single-center observational retrospective cohort study included included 137 consecutive patients who underwent pars plana vitrectomy and gas tamponade for primary RRD with increased aqueous flare between July 2016 and June 2021. From June 2019, an intravitreal injection of bevacizumab was administered as an adjunct to RRD repair. Patients who underwent surgery before this time and who did not receive intravitreal bevacizumab served as controls. The main outcome was the rate of retinal redetachment due to PVR. Results: The median flare value was 22.0 [16.5-36.5] pc/ms in the control group and 28.2 [19.7-41.0] pc/ms in the bevacizumab group (p=0.063). Eyes treated with bevacizumab were more likely to have macula-off RRD (p=0.003), grade B PVR (p=0.038) and worse visual acuity (p=0.004) than controls. The rate of PVR redetachment was significantly lower in the bevacizumab group (11.1%) than in the control (30.1%) (p=0.012). This difference was more pronounced after adjusting for potential confounding factors (p=0.005); the risk of developing PVR was 4.5-fold higher in controls (95%CI, 1.6-12.8). After adjustment, the final median visual acuity was also significantly higher in eyes treated with bevacizumab (p=0.025). Conclusion: This pilot study provides preliminary evidence that bevacizumab may reduce the risk of PVR-related recurrent RRD and improve visual outcomes in high-risk patients selected by laser flare photometry

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Section: Discussionmentioning

confidence: 99%

Intravitreal Injection of Bevacizumab for the Prevention of Postoperative Proliferative Vitreoretinopathy in High-Risk Patients Selected by Laser Flare Photometry

Gahon,

Luc,

Zessler

et al. 2023

Ophthalmologica

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“…The formation of PVR after retinal reattachment surgery is a frustrating event to retinal surgeons. In the past two decades, various drugs including steroids ( 32 ), methotrexate ( 8 , 33 ), isotretinoin ( 7 ), and anti-VEGF reagents ( 9 ) have been tested in clinical trials to prevent postoperative PVR. However, none of them was routinely used in patients with RD due to the uncertainty of efficacy and possible retinal toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…The inflammation process, as well as the proliferation and migration of retinal pigment epithelium (RPE) cells, glial cells, and macrophages, are involved in the onset and development of PVR (6). Based on the understanding of these pathogeneses, various anti-inflammatory, and anti-metabolic drugs have been used in clinical trials to prevent the formation of postoperative PVR (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Combined 5-Fluorouracil and Low Molecular Weight Heparin for the Prevention of Postoperative Proliferative Vitreoretinopathy in Patients With Retinal Detachment: A Meta-Analysis

Chen

Liu

et al. 2021

Front. Med.

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Background: Postoperative proliferative vitreoretinopathy (PVR) remains a dilemma for retinal surgeons. We performed a literature search and meta-analyses to figure out whether combined 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH) treatment were effective in improving the primary success of vitrectomy and preventing postoperative PVR occurrence in patients with retinal detachment (RD).Methods: Databases including PubMed, Embase, the Cochrane library, and China National Knowledge Infrastructure (CNKI) were searched from inception to May 2021. Comparative studies approaching the effects of combined 5-FU and LMWH on postoperative PVR were included. Quality assessment was performed using RoB 2 and ROBINS-I tool. Study data were pooled using Review manager 5.4.1. The main outcomes were: the primary success of vitrectomy at 6 months and the postoperative PVR occurrence. The additional outcomes were: number of patients who underwent vitreoretinal reoperations and the number of vitreoretinal reoperations due to postoperative PVR. Subgroup analyses and sensitivity analyses were also performed.Results: Six clinical trials with a total of 1,208 participants were included. We found that combined 5-FU and LMWH infusion did not improve the primary success of vitrectomy at 6 months (RR = 1.00, 95% CI = 0.95, 1.07, P = 0.89, I2 = 50%). Also, the conjunct therapy had no effect on reducing the number of patients who underwent vitreoretinal reoperations (RR = 1.00, 95% CI = 0.78, 1.28, P = 1.00, I2 = 42%). The overall effect of the treatment on preventing postoperative PVR was negative. However, in patients with PVR grade C (PVRC) before intervention, the 5-FU and LMWH treatment significantly reduced PVR occurrence. Visual acuity was not different between the treatment and control groups. Nevertheless, in one RCT, a significant reduction of VA was observed in the treatment group in macular-sparing patients with RD. No complications were attributed to the conjunct therapy.Conclusions: The combined 5-FU and LMWH treatment neither improved the primary success of vitrectomy at 6 months nor decreased number of patients who underwent vitreoretinal reoperations. Thus, the treatment should not be routinely used in vitrectomy for patients with RD. However, the treatment proved beneficial in reducing postoperative PVR in patients with PVRC before intervention. More high-quality clinical trials are needed to confirm the results.Systematic Review Registration:https://inplasy.com/inplasy-2021-8-0117/, identifier: INPLASY202180117.

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“…Another small study found that adjunctive intravitreal bevacizumab following PPV for eyes with RD with up to grade B PVR did not lead to improved anatomic success or improved best-corrected visual acuity at either 3 or 6 months. 19 Finally, one study explored whether serial intra-SiO bevacizumab injections given intraoperatively and at postoperative months 1, 2, and 3 had benefits for patients undergoing PVR-related surgery. 20 The study found no improvement in retinal reattachment rate or visual acuity in the bevacizumab group versus control.…”

Section: Pharmacologic Treatments For Pvrmentioning

confidence: 99%

Proliferative Vitreoretinopathy: Pathophysiology and Therapeutic Approaches

Lin,

Wu,

Kim

2024

International Ophthalmology Clinics

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Intravitreal injection of bevacizumab in primary vitrectomy to decrease the rate of retinal redetachment: A randomized pilot study

Cited by 15 publications

References 30 publications

Intravitreal Injection of Bevacizumab for the Prevention of Postoperative Proliferative Vitreoretinopathy in High-Risk Patients Selected by Laser Flare Photometry

Intravitreal Injection of Bevacizumab for the Prevention of Postoperative Proliferative Vitreoretinopathy in High-Risk Patients Selected by Laser Flare Photometry

Combined 5-Fluorouracil and Low Molecular Weight Heparin for the Prevention of Postoperative Proliferative Vitreoretinopathy in Patients With Retinal Detachment: A Meta-Analysis

Proliferative Vitreoretinopathy: Pathophysiology and Therapeutic Approaches

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