Abstract
Purpose:
To evaluate the effect of preoperative intravitreal bevacizumab on outcomes in diabetic tractional retinal detachment repair.
Methods:
Retrospective chart review of all patients who underwent 23-gauge pars plana vitrectomy for tractional retinal detachment (TRD) repair performed by a single surgeon over a 13 month period from November 2012 to November 2013 at a single academic center. Cases of diabetic vitreous hemorrhage without TRD were excluded. Mean follow-up was 4 months (range 1 to 12 months). Outcome measures include logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA), mean surgical time, incidence of iatrogenic retinal breaks, postoperative hemorrhage and macular edema.
Results:
27 eyes from twenty-six patients were included in this study (n= 18 foveal sparing TRD; n= 9 foveal involving TRD). Mean age was 52 years (range 36 to 67). Twenty-two eyes received preoperative intravitreal bevacizumab 2-3 days prior to vitrectomy and 7 eyes did not. Incidence of intraoperative iatrogenic breaks was significantly reduced by preoperative bevacizumab (10% vs 43%, p=0.05) with a trend towards shorter mean operative time. There was also a non-significant trend towards lower incidence of postoperative hemorrhage in bevacizumab treated eyes (15% vs 43%, p=0.13). Postoperative macular edema was not significantly different between the two groups (40% with bevacizumab vs 43% without, p=0.90). Mean logMAR BCVA was similar preoperatively (1.7±1.0 with bevacizumab vs 1.7±0.9 without, p=0.96) and 1 month postoperatively (1.2±1.0 with bevacizumab vs 1.7±0.8 without, p=0.25). Subset analysis showed that in foveal involving TRD, mean preoperative logMAR visual acuity was similar (1.1±0.6 with bevacizumab vs 2.0±0.9 without, p=0.11); however, bevacizumab treated eyes achieved significantly better BCVA at 1 month (0.7±0.2 with bevacizumab vs 2.0±0.9 without, p=0.02)
Conclusions:
Preoperative intravitreal bevacizumab helps reduce incidence of iatrogenic breaks during repair of diabetic tractional retinal detachment and may also help reduce operative time, most likely due to less intraoperative bleeding. Postoperative hemorrhage appeared less frequently in eyes pretreated with bevacizumab, consistent with findings in the literature. We suggest that preoperative intravitreal bevacizumab be routinely used prior to surgical repair of diabetic tractional retinal detachments.
Keywords: 688 retina •
697 retinal detachment •
499 diabetic retinopathy