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R. L. Avery, D. Pieramici, M. Rabena, A. Castellarin, M. Nasir, M. Giust; Intravitreal Bevacizumab (Avastin®) in the Surgical Treatment of Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4031.
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To assess the use of preoperative intravitreal bevacizumab (IVB) in surgery for proliferative diabetic retinopathy (PDR).
A retrospective chart review of consecutive patients who received IVB prior to undergoing vitrectomy for vitreous hemorrhage, tractional retinal detachment, or neovascular glaucoma secondary to PDR. Patients underwent complete ophthalmic examination with nonstandardized Snellen visual acuity. Evaluation of neovascularization (NV) by fluorescein angiography (FA) was performed when the fundus was visible.
This study evaluated 57 eyes of 52 patients (36 men and 16 women). Follow-up ranged from 2 weeks to 10 months with a mean of 4.1 months. Most patients received a single injection (Range 1 to 3, Median 1) of bevacizumab at an average of 31 days prior to surgery. Partial or complete resolution of NV following IVB was demonstrated in all patients evaluated by FA. A reduction of intraoperative bleeding while cutting fibrovascular proliferations (FVP) during vitrectomy was noted and documented by video. Mean Snellen visual acuity improved from 20/CF5’ prior to vitrectomy to 20/200- (Range LP to 20/50, Median 20/200- ) at the last follow-up visit (P< 0.05). One patient was noted to develop contraction of FVP one week after injection, and progressed to a traction rhegmatogenous retinal detachment three weeks later which was successfully repaired. Recurrent vitreous hemorrhage was noted in 14 of 57 eyes (25%), and postoperative retinal detachment occurred in one eye. No significant systemic side effects were observed.
Preoperative intravitreal bevacizumab induces a rapid regression of diabetic ocular neovascularization which appears to result in less intraoperative bleeding, suggesting a potential role for IVB as a surgical adjunct. Increased rates of preoperative traction retinal detachment and post-operative vitreous hemorrhage may be adverse side-effects of preoperative IVB. Further investigation is warranted.
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