Bevacizumab (Avastin) as an Adjunct to Vitrectomy in the Management of Severe Proliferative Diabetic Retinopathy: A Prospective Case Series
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- Category: Vol. 77, December 2009
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Bevacizumab (Avastin) as an Adjunct to Vitrectomy in the Management of Severe Proliferative Diabetic Retinopathy: A Prospective Case Series, MOHAMAD AMR S. ABDELHAKIM, TAMER A. MACKY, KHALED A. MANSOUR and HASSAN A. MORTADA
Abstract
Purpose: To evaluate the role of preoperative intravitreal bevacizumab as an adjunct to vitrectomy in the management of severe diabetic eye disease.
Settings: Kasr El-Aini Teaching Hospital – Cairo Univer-sity from 2007 to 2008.
Methods: Twenty eyes of 19 patients with severe prolif-erative diabetic retinopathy were recruited into the study. All eyes underwent a single intravitreal injection of bevacizumab 1.25 mg in 0.05 ml one week prior to vitrectomy for tractional (14), combined tractional/rhegmatogenous retinal detachment (4), and fibrovascular tissue covering/distorting the macula (2). Exclusion criteria were: previous vitrectomy, neovascular glaucoma, and dense media opacity (dense cataract and vitreous hemorrhage) precluding fluorescein angiography (FA) that was done pre- and 1 week post injections. Best corrected visual acuity (BCVA), anterior segment with dilated fundus examinations, and intraocular pressures (IOP), were done pre, 1 week post-injections, 1 day, 1 week and monthly for 3 months post-vitrectomy. Intra- and post-operative bleedings were recorded.
Results: Mean age was 47.7±10.39 years (range 23–67). Male: Female ratio was 2:3. Eleven patients had IDDM (Type I) and 9 had NIDDM (Type II). Mean duration of diabetes 14.65±6.97 years (range: 9–38). Two patients were hyperten-sive. Eight patients had laser in the study eyes. Mean pre-injection BCVA (log MAR) was 1.4600±0.43938 (range 0.5- 2.0). FA showed dramatic reduction in dye leakage one week post injection. Intraoperative bleedings were minimal in most cases. Postoperatively: 16 patients had no bleeding, 4 had minimal bleeding, 1 had recurrent fibrovascular proliferation. The mean BCVA on the day 1 and 3 months postoperative were 1.6450±0.422 logMAR and 1.0650±0.538 logMAR, respectively. Both were statistically significant compared to preinjections, (p=0.037 and 0.018, respectively).
Conclusion: Bevacizumab administered prior to vitrectomy was well tolerated and reduced active neovascularization. It improved the ease of the surgery in these complex eyes and found to be particularly useful during vitrectomy in diabetic eyes in which there is still active neovascularization.