Role of Intravitreal Bevacizumab (Avastin) Injected at the End of Diabetic Vitrectomy in Preventing Postoperative Recurrent Vitreous Hemorrhage

Cheema, Rizwan A.; Mushtaq, Javed; Al-Khars, Wajeeha; Al-Askar, Essam; Cheema, Maheera A.

doi:10.1097/iae.0b013e3181d6def0

Cited by 41 publications

(34 citation statements)

References 27 publications

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“…9,12 IVB after a vitrectomy also appears safe and effective for reducing postoperative VH, albeit without the benefit on final visual acuity. 21,22 In a randomized clinical trial, 25.7% of patients avoided the need for vitrectomy after IVB injection. 23 Although PRP is the principal therapy for PDR, substantial regression of NV may take weeks after completion of laser treatment, and it is not always effective.…”

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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“…It has been found to reduce intraoperative bleeding, provide a clear field for vascular epiretinal tissue dissection, and reduce the chance of recurrent hemorrhage [18,19,21,22]. Although tractional retinal detachment has been reported as a complication in these cases [20,22], secondary RRD as a complication of intravitreal bevacizumab has not been reported. This is despite the fact that neovascularization and fibrovascular proliferation is also seen in the natural course of proliferative diabetic retinopathy.…”

Section: Discussionmentioning

confidence: 92%

“…Median age of the study population was 33 yrs (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). The patients had presented with a median duration of vitreous hemorrhage of 5 months (3-7).…”

Section: Resultsmentioning

confidence: 99%

Secondary rhegmatogenous retinal detachment following intravitreal bevacizumab in patients with vitreous hemorrhage or tractional retinal detachment secondary to Eales’ disease

Kumar

Sehra

Thirumalesh

et al. 2011

Graefes Arch Clin Exp Ophthalmol

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“…23 Some investigators have suggested the use of bevacizumab at the end of operation to reduce postoperative hemorrhage induced by early growth of neovascularization. 24,25 We injected 0.05 mg of bevasizumab before silicone oil infusion in an attempt to inhibit early postoperative neovascularization. The exact effect of the treatment in a silicone oil-filled eye remains to be studied.…”

Section: Discussionmentioning

confidence: 99%

Distribution, reabsorption, and complications of preretinal blood under silicone oil after vitrectomy for severe proliferative diabetic retinopathy

Yeh

2012

Eye

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Purpose To examine the evolution and complications of preretinal hemorrhage under silicone oil after diabetic vitrectomy. Methods A total of 44 cases of primary diabetic vitrectomy with silicone oil infusion were reviewed in a 3-year period. Intravitreal bevacizumab was used preoperatively for cases with active proliferation, and in all cases at the end of surgery. Intraoperative bleeding, postoperative extent of preretinal hemorrhage, blood reabsorption time, and reproliferation and treatment results were assessed. Results Maximal blood distributed in thin and scattered patterns (23 cases), thick and localized patterns (10 cases), or thick and scattered patterns (10 cases) developed within 1 week after surgery, and was largely reabsorbed within a month with improved postoperative vision. Confluent blood extending to the midperiphery (one case) resulted in severe fibrosis and detachment. Complications included fibrotic plaque (two cases), and fibrous band and thick membrane (seven cases). Six cases underwent preretinal tissue removal. Vision improvementZ3 lines was noted in three cases. Conclusion Most of the rebleeding occurred within the first post-op week, with gradual reabsorption in the posterior pole within 4 weeks; widespread confluent bleeding might result in severe reproliferation and detachment. A major complication of preretinal bleeding was the formation of preretinal fibrosis. Re-operation achieved a mild VA improvement.

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Role of Intravitreal Bevacizumab (Avastin) Injected at the End of Diabetic Vitrectomy in Preventing Postoperative Recurrent Vitreous Hemorrhage

Cited by 41 publications

References 27 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

Secondary rhegmatogenous retinal detachment following intravitreal bevacizumab in patients with vitreous hemorrhage or tractional retinal detachment secondary to Eales’ disease

Distribution, reabsorption, and complications of preretinal blood under silicone oil after vitrectomy for severe proliferative diabetic retinopathy

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