Purchase this article with an account.
F. Genovesi-Ebert, S. Rizzo, E. Di Bartolo, S. Miniaci, A. Vento, M. Palla, F. Cresti; Injection of Intravitreal Avastin Before Vitrectomy Surgery in the Treatment of Severe Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5044.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Despite the success of pars plana vitrectomy (ppv) in managing severe proliferative diabetic retinopathy (PDR) significant operative and postoperative complications still occur.Intravitreal injection of Avastin (IVA)(Bevacizumab), a VEGF inhibitor, before ppv, could be useful as it may induce a regression in retinal and iris neovascularization.
22 patients (m. age 59 ys) with severe PDR underwent ppv. Surgical indications were tractional or traction-reghmatougenous retinal detachment with vitreous hemorrage and/or neovascular glaucoma. Complexity score (CS) was recorded (1-7). 11 eyes (Group 1) 1-2 weeks before ppv were treated with a IVA (1.25 mg in 0.05 ml). Main outcome measure was: feasibility and safety of surgery. In order to evaluate whether surgery was easier, we recorded surgical time, intra-operative bleeeding, cataract surgery, bimanual membrane (M) dissection and/or peeling under PFCL, number of blunt M removal, use of endodiatermy
At inclusion in the study, patients’average CS was 5.5 (4.5-6.2) and was similar in the two groups. Preoperative VA ranged from light perception to counting fingers. Group 1 showed a marked reduction of the CS (mean 3.7, range 3-4.6) at the time of the surgery (2 weeks after IVA). Anatomical attachment was achieved in 11 eyes in group1, in 9 in group 2. Surgical intraoperative records were: Group 1: Mean surgical time 57 minutes, cataract surgery 2, bimanual M dissection 8, blunt M removal 5, M peeling under PFCL 1, intraoperative bleeding 2, endodiatermy 0, intraoperative retinal breaks 0. Group 2 : Mean surgical time: 83 minutes, cataract surgery 6, bimanual M dissection 32, blunt M removal 0, M peeling under PFCL 11, intraoperative bleeding 10, endodiatermy 7, intraoperative retinal breaks 7.No complications were recorded after IVA and intraoperatively
IVA reduced the retinal and iris neovascularization within 2 weeks: PPV was therefore shorter, easier and safer in group 1 in respect with group 2. These are short-term results but have been promising and show the need for further investigations.
This PDF is available to Subscribers Only