Clearance of disbetic vitreous hemorrhage with and without intravitreous bevicizumab

Abstract

Purpose: Although the usefulness of vascular endothelial growth factor (VEGF) inhibition for suppression of diabetic vitreous hemorrhage is widely accepted, there is a paucity of information to prove and quantify the effectiveness of this VEGF inhibition. Although Bevacizumab does not clear hemorrhages, it holds theoretical potential to inhibit re-bleeding. However, there is a lack of evidence systematically comparing patients who receive Bevacizumab treatment with those who do not. We retrospectively compared the time to clearance of diabetic vitreous hemorrhage in patients receivning Bevicizumab and those with observation only.

Methods: Fifty eight patients with vitreous hemorrhage due to proliferative diabetic retinopathy were evaluated retrospectively. Complete hemorrhage clearance and time to clearance were the results recorded for patients initially treated with either 1 intravitreal bevacizumab injection or observation only. Patients in both groups underwent subsequent treatments with bevacizumab injection, panretinal photocoagulation, vitrectomy, or a combination based upon clinical judgement of their hemorrhage progression. Kaplan-Meier survival curves were compared between the two groups using a log-rank test with hemorrhage clearance as the end point.<br /> <br /> <br /> <br />

Results: Survival curves between both groups were nearly identical with median time to clearance of 229 days (mean 275 days). Average time to clearance for eyes clearing after 1 bevacizumab injection was 119 days whereas average time to clearance for eyes that clear with observation only is 256 days.<br /> <br /> <br /> <br />

Conclusions: Clearance of diabetic vitreous hemorrhage is likely be a multifactorial process. While VEGF inhibition may have potential to suppress vitreous hemorrhage this suppression is likely to be time limited and the exact role of this therapy remains to be demonstrated. Further, prospective study of this treatment is needed..