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

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

doi:10.3341/jkos.2009.50.8.1221

Journal List > J Korean Ophthalmol Soc > v.50(8) > 1008338

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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

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.

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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.

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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.

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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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