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Grant Guthire, Anthony Hall, Kazim Dhalla; Bevacizumab As An Adjunct To Vitrectomy In The Management Of Proliferative Diabetic Retinopathy In East Africa. Invest. Ophthalmol. Vis. Sci. 2012;53(14):361.
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Diabetes mellitus is an important public health problem worldwide. In sub-Saharan Africa, its current incidence is 12 million. Although proliferative diabetic retinopathy (PDR) can be treated with laser some patients will need a vitrectomy. Preoperative intravitreal use of the antiangiogenic bevacizumab (IVB) has been shown to reduce intraoperative complications by improving retinal visualization. The following multi-centre retrospective audit is the first study to assess surgical outcomes and the cost-effectiveness of IVB in vitrectomy for PDR in an East African context.
Eight years of case notes from patients undergoing vitrectomy for PDR retinopathy were retrospectively analysed. The later four years saw the commencement of routine use of IVB (1.25mg 4-9 days prior to operating). All patients with follow-up of at least six weeks were included. Surgery was performed by three different vitreoretinal surgeons at two hospitals in East Africa (Kilimanjaro Christian Medical Centre, Tanzania and Kikuyu Eye Unit, Kenya).
Initial data was compiled for 140 patients (158 eyes). Of the included eyes 46 (43%) had received IVB the remaining 62 (57%) had not. The main indications for surgery were vitreous haemorrhage (39%) and tractional retinal detachment (54%). The majority of patients required delamination surgery (81%). The distribution of the above surgical indications and requirements was even to within 4% between the two groups. Intraoperative complications were higher in the patients who had not received IVB. Significant haemorrhage occurred in 8 (11%) compared to 1 (1.8%) in those who had received IVB. Similarly iatrogenic breaks were more common, 33 (44.6%) to 19 (35%). The number needed to treat to restore sight to one blind person (both eyes < 20/200) was 5.1 for those who received IVB and 7.7 for those who did not.
This is the first study to indicate that a relatively inexpensive preoperative dose of bevacizumab can improve surgical outcomes in PRD surgery in East Africa. The improved outcomes are largely a result of Bevacizumab antiangeogentic actions improving intraoperative visualization of the retina. This audit shows that IVB should be considered a cost-effective intervention in the treatment of PDR in the developing world.
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