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W. R. Lo, S. Kim, S. Srivastava, J. Yan, G. B. Hubbard, III, D. F. Martin, T. M. Aaberg, Sr.; Bevacizumab (Avastin) Pre-Treatment for Vitrectomy in Diabetic Vitreous Hemorrhage and Tractional Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2007;48(13):261.
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To determine if pre-operative intravitreal bevacizumab (Avastin) injections in diabetic patients scheduled for pars plana vitrectomy (PPV) decrease the incidence of rebleed in the post-operative period.
This is a retrospective, consecutive, interventional, nonrandomized comparative study. A chart review was conducted examining operative results of patients undergoing PPV for either non-clearing vitreous hemorrhage (NCVH) or tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy. The study group received 1.25 mg of intravitreal bevacizumab 2-4 weeks prior to surgery. The control group received no injection. Incidence and severity of rebleed was examined through the first post-operative month. Patients receiving silicone oil during surgery were excluded.
6 patients received bevacizumab prior to surgery--2 patients with TRD and 4 with both NCVH and TRD. During the same period, 11 diabetic patients underwent PPV without pre-operative bevacizumab. 1 patient in the study group developed a rhegmatogenous retinal detachment post-operatively. 2 of the remaining 5 (40%) in the study group had evidence of rebleed at one month. 3 of 11 (27%) in the control group had rebleed at one month.
Pre-operative intravitreal bevacizumab has been reported to improve ease of diabetic vitrectomy by reducing intraoperative hemorrhage. These results suggest that bevacizumab injections may not reduce the rate of rebleed in diabetic patients following pars plana vitrectomy. Patient selection bias--injecting those patients with worse diabetic retinopathy and anticipated surgical complexity--may play a role.
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