Outcomes of preoperative bevacizumab in diabetics with nonclearing vitreous hemorrhage without tractional detachment – A quasi-randomized retrospective study

Abstract

Purpose: To assess whether preoperative bevacizumab (BVZ) in treatment-naïve eyes with proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH) without tractional retinal detachment (TRD) leads to lesser macular edema and better visual outcome compared to eyes that do not receive BVZ. Methods: This quasi-randomized retrospective study included 217 treatment-naïve eyes with nonclearing VH without TRD that had vitrectomy with or without BVZ and had a minimum 6-months follow-up. Postoperative variables, including visual acuity (BCVA), central macular thickness (CMT) at 1 month, and need for additional anti-VEGF injections till 6 months follow-up, were recorded for analysis. Results: Of the 217 eyes, 107 eyes (49%) received preoperative BVZ and 110 (51%) did not. Groups were comparable in terms of preoperative characteristics. At 1 month, mean CMT was significantly higher in eyes without BVZ (310 ± 33 μ vs. 246 ± 34μ; P < 0.001). The likelihood of developing center-involving DME at 1 month after vitrectomy was 67% lower if the eye received preoperative BVZ (OR = 0.33, 95%CI = 0.18–2.54, P = 0.56). Though BCVA improved significantly in both groups at 1 month, it was 1/3 rd of a line better in the BVZ group (β coefficient = −0.035 logMAR, 95%CI = −0.04 to −0.008 logMAR, P = 0.01). Conclusion: Preoperative BVZ in treatment-naïve eyes with PDR and VH but without TRD lead to better macular status and marginally improved vision at 1 month, which was maintained at 6 months. In view of these results, patients may be offered BVZ only when it is readily affordable to them.

Update on the Management of Diabetic Retinopathy: Anti-VEGF Agents for the Prevention of Complications and Progression of Nonproliferative and Proliferative Retinopathy

“…Postoperatively, the benefits of anti-VEGF pre-treatment prior to PPV include superior visual acuity up to at least six months, shorter time to vitreous clearance, lower rates of postoperative hemorrhage, decreased likelihood of developing new CI-DME, and decreased risk of new tractional retinal detachment [ 62 , 63 , 64 , 65 ]. Considering the agreement across many studies, it seems that these benefits are shared across any of the anti-VEGF agents.…”

Commentary: Outcomes of preoperative bevacizumab in diabetics with nonclearing vitreous hemorrhage without tractional detachment – A quasi-randomized retrospective study

“…[ 1 2 ] The authors of the study published in the recent issue of the Indian Journal of Ophthalmology must be congratulated to show the extended beneficial effects of IVB in this context on reducing diabetic macular edema (DME). [ 3 ] The authors have pragmatically included patients with comparable preoperative baseline characteristics like HbA1C, serum creatinine, insulin dependency; all of which have been proved to affect the DME. [ 4 ]…”

“…There are certain comments on the current study. [ 3 ] First, the authors mention that both the groups of patients, i.e., with or without preoperative IVB were postoperatively found to be comparable with respect to the optical coherence tomography (OCT) biomarkers like an epiretinal membrane, hyperreflective foci, and ellipsoid zone disruption and irregularity. However, certain biomarkers like cystic cavities suggestive of chronic DME and central plaque-like hard exudates have adverse effects on the vision in the eyes irrespective of the thickness of the central retina.…”