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Shin, Kim, Lee, and Oum: Intravitreal Bevacizumab Injection as Preoperative Adjuvant of Vitrectomy for Proliferative Diabetic Retinopathy
Original Article

J Korean Ophthalmol Soc 2009;50(5):731-737.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.5.731

Intravitreal Bevacizumab Injection as Preoperative Adjuvant of Vitrectomy for Proliferative Diabetic Retinopathy

Min Kyu Shin, MD1, Na Mi Kim, MD1, Ji Eun Lee, MD, PhD1, 2, Boo Sup Oum, MD, PhD1, 2

1Department of Ophthalmology, School of Medicine, Pusan National University, Busan, Korea

2Medical Research Institute, Pusan National University, Busan, Korea

Address reprint requests to Ji Eun Lee, MD, PhD Department of Ophthalmology, Pusan National University Hospital #1-10, Ami-dong, Seo-gu, Busan 602-739, Korea Tel: 82-51-240-7957, Fax: 82-51-242-7341, E-mail: jlee@pusan.ac.kr

Received 3 September 2008       Accepted 10 February 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

The effect of preoperative intravitreal bevacizumab (Avastin®) injection was investigated in primary vitrectomy for severe proliferative diabetic retinopathy.

Methods

Eyes that underwent vitectomy for proliferative diabetic retinopathy were followed up at least 6 months and were reviewed retrospectively. The authors reviewed functional outcomes, complications, and operation time between preoperative bevacizumab injection (group I) and non-injection groups(group II).

Results

Among 93 eyes of 87 patients, the injection group consisted of 44 eyes of 41 patients and the non-injection gauge group consisted of 49 eyes of 46 patients. The mean interval between injection and vitrectomy was 5.8 days. Final visual acuity significantly improved as compared to preoperative visual acuity, and group I showed better visual acuity than group II (p=0.008). Visual acuity improved logMAR 0.2 or more in 36 eyes in group I and 43 eyes in group II (p=0.167). The average duration of postoperative vitreous hemorrhage was 1.02 days in group I, and 4.02 days in group II (p=0.2.08). Recurrence of vitreous hemorrhage was not observed in group I or in 2 eyes of group II (p=0.274). Epiretinal membrane occurred in 2 eyes of group I, and in 9 eyes of group II (p=0.031). Only a single eye in group I had neovascular glaucoma after vitrectomy (p=0.527). The operation time of group I was 64.8 minutes, which was significantly shorter than 78.1 minutes of group II (p=0.018).

Conclusions

Intravitreal bevacizumab injection before vitrectomy in proliferative diabetic retinopathy facilitated removal of the fibrovascular membrane, and leads to less postoperative complications and better functional outcomes. Intravitreal bevacizumab injection before vitrectomy can be considered as an effective preoperative adjuvant.

Keywords: Bevacizumab (Avastin), Diabetic retinopathy, Epiretinal membrane, Vitrectomy, Vitreous hemorrhage

References

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Figure 1.
Average visual acuity changes after vitrectomy with and without pre-operative intravitreal bevacizumab injection for proliferative diabetic retinopathy at baseline and over a 6-month period (* p=0.008, Student t-test).
jkos-50-731f1.tif
Figure 2.
Visual acuity distribution in proliferative diabetic retinopathy with (A) and without (B) preoperative bevacizumab injection at baseline and overa 6-month period after vitrectomy.
jkos-50-731f2.tif
Table 1.
Baseline characteristics of the patients.
Group Ⅰ Group Ⅱ p
No. of eyes (patients) 44 (41) 49(46)
Age (years) 54.1±9.4 55.9±10.1 0.36*
Sex (male/female) 18/23 28/18
Preoperative visual acuity (logMAR) 1.60±0.89 1.74±0.83 0.36*
Preoperative lens status (%)
phakia 25 (56.8%) 37 (75.5%) 0.03†
pseudophakia 19 (43.1%) 12 (24.5%) 0.03†
Surgical indication
vitreous hemorrhage 25 (56.8%) 30 (61.2%) 0.15†
progressive fibrovasular proliferation 4 (9.1%) 5 (10.2%) 0.26†
vitreous hemorrhage and progressive fibrovasular proliferation 3 (6.8%) 3 (6.1%) 0.32†
tractional retinal detachment involving macula 12 (27.3%) 11 (22.4%) 0.16†
Follow-up (months) 10.8±3.03 12.8±5.97 0.06*

* Student t-test

† Fisher's exact test.

Table 2.
Time of bevacizumab injection before vitrectomy
for proliferative diabetic retinopathy.
From injection to vitrectomy No. of eyes (%)
1∼3 days 4 (9.1)
4∼6 days 30 (68.2)
7∼9 days 4 (9.1)
10∼12 days 5 (11.4)
13∼15 days 1 (2.3)
Total 44 (100.0)
Table 3.
Comparison of the operation time between with and without preoperative intravitreal bevacizumab injection for proliferative diabetic retinopathy
With injection Without injection p
Operation time* (total, minutes) 66.4±25.1 78.1±28.7 0.018†
with cataract operation 72.6±23.9 (n=23) 85.6±26.3 (n=33) 0.062†
without cataract operation 56.4±21.7 (n=21) 62.5±26.6 (n=16) 0.462†
Operation time (subtype)
vitreous hemorrahage 62.0±19.9 (n=25) 70.0±24.1 (n=30) 0.18†
progressive fibrovascular proliferation 57.5±21.8 (n=4) 84.0±7.41 (n=5) 0.09†
vitreous hemorrhage and progressive fibrovascular proliferation 71.7±14.4 (n=3) 100.5±37.0 (n=3) 0.05†
tractional retinal detachment involving macula 71.6±27.7 (n=12) 66.6±17.5 (n=11) 0.81†

* Operation time was calculated by operation record

† Student t-test.

Table 4.
Postoperative complications after vitrectomy for proliferative diabetic retinopathy with and without pre-operative injecton of bevacizumab
No. of cases (%)
with injection without injection p*
Vitreous hemorrhage recurrence 0 2 (4.08) 0.274
Neovascular glaucoma 0 1 (2.04) 0.527
Epiretinal membrane 2 (4.54) 9 (18.36) 0.031
Retinal detachment 1 (2.27) 2 (4.08) 0.398
Choroidal detachment 1 (2.27) 0 0.473
Total 4 (9.09) 14 (28.5) 0.012

* Fisher's exact test.

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