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Harpreet Walia, Richard J Rothman; Intravitreal Bevacizumab for Postoperative Vitreous Hemorrhage after Vitrectomy for Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4402.
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© ARVO (1962-2015); The Authors (2016-present)
To report the results of a series of patients who received intravitreal bevacizumab on a treat-and-extend schedule for postoperative vitreous hemorrhage after vitrectomy for complications of proliferative diabetic retinopathy.
Retrospective review of a cohort of patients with proliferative diabetic retinopathy who underwent 23 gauge pars plana vitrectomy for diabetic vitreous hemorrhage or tractional detachment who developed postoperative vitreous hemorrhage and received intravitreal bevacizumab on a treat-and-extend schedule. Medical records were reviewed for age, lens status, preoperative visual acuity, time from vitrectomy to hemorrhage, visual acuity at time of postvitrectomy hemorrhage, number of injections, and grade of vitreous hemorrhage at time of injection. Primary objective measurements included hemorrhage clearing time, number of rebleeds after initial clearing, need for additional vitrectomy, and final recorded visual acuity.
Twelve eyes from nine patients were included. Five patients were male, four were female with a mean age of 53.75 years old. At time of vitrectomy, eleven of twelve eyes (91.6%) of eyes were phakic. Mean preoperative visual acuity measured in logMAR was 1.94. The average time from vitrectomy to development of postvitrectomy hemorrhage was 255.5 days, with mean logMAR visual acuity at time of postvitrectomy hemorrhage of 1.73. A total of 97 intravitreal injections were administered with an average of 8.03 per patient. Injections were given on a treat-and-extend schedule where twenty total injections were performed for Grade 2 hemorrhage, eight total injections were performed for Grade 1 hemorrhage and sixty nine total injections were performed for Grade 0 hemorrhage. The mean vitreous hemorrhage clearing time was 35.5 days after initial intravitreal bevacizumab. A total of four rebleeds occurred after initial clearing, with no eyes requiring additional vitrectomy hemorrhage. Median final visual acuity, measured at least a minimum of six months after vitrectomy was 0.3.
In the twelve eyes presented in this series, intravitreal bevacizumab injections led a rapid clearing time with a low incidence of rebleeds and eliminated the need for additional vitrectomy. Additionally, final visual acuity measurements in this series lend support that intravitreal bevacizumab could help maintain or improve visual acuity.
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