Abstract
Purpose:
To evaluate the efficacy of preoperative intravitreal bevacizumab (AvastinⓇ; Genetech, San Francisco, CA, USA) injections of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR).
Methods:
Thirty patients (30 eyes) who underwent PPV for treatment of PDR and received a preoperative intravitreal bevacizumab injection of 1.25 mg were retrospectively analyzed. The study group (group 1, 30 patients, 30 eyes) was compared with a control group (group 2, 29 patients, 30 eyes and matched with the study group for preoperative parameters) who underwent PPV without preoperative intravitreal bevacizumab injection.
Results:
In both groups, visual acuity improved but there was no statistical significance. Intraoperative vitreous hemorrhage occurred in 14 eyes (46.7%) from group 1 and 11 eyes (36.7%) from group 2. There was no statistical significance of intraoperative bleeding occurrence (p=0.3). Postoperative vitreous hemorrhage occurred in 4 eyes from group 1 and 14 eyes from group 2. The group 1 had a lower incidence of postoperative hemorrhage than group 2 (p=0.005).
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Figure 1.
Preoperative color fundus photography of one patient in group 1. Initial presentation shows extensive fibrovacular tractional membrane overlying the optic disc.
![jkos-50-1221f1.tif](/upload/SynapseXML/0035jkos/thumb/jkos-50-1221f1.gif)
Figure 2.
Intraoperative fundus photography of one patient in group 1. Delamination of fibrovascular membrane with vertical scissors from the retina was technically easier than by conventional vitrectomy without preoperative intravitreal bevacizumab injection.
![jkos-50-1221f2.tif](/upload/SynapseXML/0035jkos/thumb/jkos-50-1221f2.gif)
Table 1.
Preoperative characteristics of each group
Group 1 bevacizumab (+) | bevacizumab (−) Group 2 | p value | |
---|---|---|---|
No. of eyes | 30 | 30 | |
No. of Patient (male) | 30 (20) | 29 (16) | |
Mean age (year) | 55.07±11.9 | 52.43±8.6 | 0.330∗ |
Duration of diabetes (year) | 14.33±6.6 | 11.90±8.0 | 0.207∗ |
Duration of follow up (month) | 13.43±2.27 | 14.10±8.48 | 0.854∗ |
Type 1/Type 2 DM | 1/29 | 1/28 | 0.954† |
HbA1c (%) | 7.82±1.60 | 8.12±2.21 | 0.576† |
Chronic renal failure (%) | 0.347† | ||
Absent | 22 (73.3%) | 25 (83.3%) | |
Present | 8 (26.7%) | 5 (16.7%) | |
Hypertension (%) | 0.602† | ||
Absent | 12 (40%) | 14 (46.7%) | |
Present | 18 (60%) | 16 (56.3%) | |
Preoperative PRP (%) | 0.638† | ||
Grade 0 | 5 (16.7%) | 7 (23.3%) | |
Grade 1 | 8 (26.6%) | 7 (23.3%) | |
Grade 2 | 17 (56.7%) | 16 (53.4%) | |
Lens status | 0.559† | ||
Phakic | 21 (70%) | 23 (76.7%) | |
Pseudophakic | 9 (30%) | 7 (23.3%) | |
Surgical indication | |||
Progressive fibrovascular proliferation | 1 (3.3%) | 0 (0%) | |
Tractional retinal detachment | 6 (20.0%) | 9 (30%) | |
Vitreous hemorrhage | 23 (76.7%) | 21 (70%) |
Table 2.
Comparison of the preoperative and postoperative BCVA∗
Group 1 bevacizumab (+) | Group 2 bevacizumab (−) | p value† | |
---|---|---|---|
Preoperative BCVA (logMAR) | 1.28±0.75 | 1.57±0.95 | 0.913 |
Postoperative BCVA (logMAR) | 0.44±0.46 | 0.53±0.33 |
Table 3.
Complications in each group, number of eyes (%)
Group 1 bevacizumab (+) | Group 2 bevacizumab (−) | p value∗ | |
---|---|---|---|
Intraoperative bleeding | 14 (46.7%) | 11 (36.7%) | 0.3 |
Postoperative bleeding | 4 (13.3%) | 14 (46.7%) | 0.005 |
Transient ocular hypertension | 7 (23.3%) | 9 (32.1%) | 0.324 |