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J. S. Brown, T. H. Mahmoud; Pre-Operative Avastin and Systemic Anticoagulation Effects on Post-Operative Vitreous Hemorrhage in Diabetic Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1356.
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To assess the interaction of pre-operative Avastin and systemic anticoagulation on the incidence of persistent and recurrent post-operative vitreous hemorrhage (POVH) in diabetic vitrectomy (PPV).
Retrospective chart review between 11/06-11/08 of patients who underwent a diabetic PPV. Demographics, use of systemic anticoagulants, pre and post-operative visual parameters, use of Avastin, operative times, peri-operative complications, and POVH (defined as no ophthalmoscopic view to the posterior fundus) was noted for all subjects.
86 eyes of 73 subjects were identified who underwent a diabetic PPV. 63 eyes of 55 subjects were included after 23 eyes of 18 subjects were excluded for post-operative follow-up duration of less than 3 months. 24 eyes (38%) received pre-operative Avastin 2-10 days before surgery and of these 6 (25%) developed POVH, where as of the 39 eyes that did not receive Avastin only 3 (8%) developed POVH. Of all subjects, 17 (27%) were on anticoagulation (aspirin alone or in combination with plavix or coumadin) at the time of surgery. In eyes exposed to anticoagulation, 3 (13%) developed POVH compared to 6 (17%) in eyes not exposed to anticoagulation. There were no perioperative complications related to the anticoagulation and no retrobulbar hemorrhages.Compared to the 54 eyes that did not develop POVH, the 9 (14%) eyes of 7 patients who developed POVH had similar demographics but had more severe diabetic disease. In the POVH group, operative times were longer (average: 2:23 compared to 2:01 minutes), they were more likely to have gotten pre-operative avastin (67% compared to 33%), the primary indication for surgery was tractional macular detachment in 57% compared to 48% , and 33% compared to 11% required repeat vitrectomy for post-operative complications (POVH, retinal detachments, epiretinal membranes, etc). Eyes in the two groups were equally likely to have been on anticoagulation at the time of surgery (about 1/3 of eyes). Of the 9 eyes developing significant POVH: 5 had persistent hemorrhage, 4 which cleared spontaneously between 7-16 weeks post-operatively and 1 required Avastin followed by a vitrectomy; 4 eyes had recurrent POVH that recurred between 3-4 months post-operatively, 2 which cleared spontaneously within 1 month, 2 required repeat PPV.
Eyes that received pre-operative Avastin appeared to have a higher incidence of POVH whereas systemic anticoagulation did not seem to alter the incidence of significant POVH. Patient selection bias likely plays a role in the observed results.
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