March 2012
Volume 53, Issue 14
ARVO Annual Meeting Abstract  |   March 2012
Bevacizumab As An Adjunct To Vitrectomy In The Management Of Proliferative Diabetic Retinopathy In East Africa
Author Affiliations & Notes
  • Grant Guthire
    Newcastle Medical School, Newcastle Upon Tyne, United Kingdom
  • Anthony Hall
    Kilmanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
    Kikuyu Eye Unit, Kikuyu, Kenya
  • Kazim Dhalla
    Kilmanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
  • Footnotes
    Commercial Relationships  Grant Guthire, None; Anthony Hall, None; Kazim Dhalla, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 361. doi:
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      Grant Guthire, Anthony Hall, Kazim Dhalla; Bevacizumab As An Adjunct To Vitrectomy In The Management Of Proliferative Diabetic Retinopathy In East Africa. Invest. Ophthalmol. Vis. Sci. 2012;53(14):361.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : Diabetes mellitus is an important public health problem worldwide. In sub-Saharan Africa, its current incidence is 12 million. Although proliferative diabetic retinopathy (PDR) can be treated with laser some patients will need a vitrectomy. Preoperative intravitreal use of the antiangiogenic bevacizumab (IVB) has been shown to reduce intraoperative complications by improving retinal visualization. The following multi-centre retrospective audit is the first study to assess surgical outcomes and the cost-effectiveness of IVB in vitrectomy for PDR in an East African context.

Methods: : Eight years of case notes from patients undergoing vitrectomy for PDR retinopathy were retrospectively analysed. The later four years saw the commencement of routine use of IVB (1.25mg 4-9 days prior to operating). All patients with follow-up of at least six weeks were included. Surgery was performed by three different vitreoretinal surgeons at two hospitals in East Africa (Kilimanjaro Christian Medical Centre, Tanzania and Kikuyu Eye Unit, Kenya).

Results: : Initial data was compiled for 140 patients (158 eyes). Of the included eyes 46 (43%) had received IVB the remaining 62 (57%) had not. The main indications for surgery were vitreous haemorrhage (39%) and tractional retinal detachment (54%). The majority of patients required delamination surgery (81%). The distribution of the above surgical indications and requirements was even to within 4% between the two groups. Intraoperative complications were higher in the patients who had not received IVB. Significant haemorrhage occurred in 8 (11%) compared to 1 (1.8%) in those who had received IVB. Similarly iatrogenic breaks were more common, 33 (44.6%) to 19 (35%). The number needed to treat to restore sight to one blind person (both eyes < 20/200) was 5.1 for those who received IVB and 7.7 for those who did not.

Conclusions: : This is the first study to indicate that a relatively inexpensive preoperative dose of bevacizumab can improve surgical outcomes in PRD surgery in East Africa. The improved outcomes are largely a result of Bevacizumab antiangeogentic actions improving intraoperative visualization of the retina. This audit shows that IVB should be considered a cost-effective intervention in the treatment of PDR in the developing world.

Keywords: diabetic retinopathy • vitreoretinal surgery • retinal neovascularization 

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