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Gang, Jae, Woo, and Ha: Effectiveness of Preoperative Intravitreal Bevacizumab Injections in Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy
Original Article

J Korean Ophthalmol Soc 2009;50(8):1221-1225.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.8.1221

Effectiveness of Preoperative Intravitreal Bevacizumab Injections in Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy

Seok Jeon Gang, MD, Ryong Han Jae, MD, Ho Nam Woo, MD, Kyoung Kim Ha, MD

Department of Ophthalmology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea

Address reprint requests to Ha Kyoung Kim, MD Department of Ophthalmology, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University #948-1 Daerim 1-dong, Yeongdeungpo-gu, Seoul 150-071, Korea Tel: 82-2-829-5193, Fax: 82-2-848-4638, E-mail: ophkim@hallym.or.kr

Received 19 February 200923 April 2009

Copyright © 2009 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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).

Conclusions:

Preoperative intravitreal bevacizumab injection appears effective in decreasing early postoperative vitreous hemorrhage and maybe technically helpful in PPV for PDR.

Keywords: Bevacizumab (AvastinⓇ), Pars Plana Vitrectomy, Proliferative diabetic retinopathy

References

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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
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
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%)  

Data are number or mean± SD.

∗ Ttest

† Chi-square test.

Statistical significance was defined was at a p<0.05.

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  

∗ BCVA=Best corrected visual acuity

† Ttest.

Statistical significance was defined was at a p<0.05.

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

∗ Chi-square test.

Statistical significance was defined was at a p<0.05.

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