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E. Chou, G. Abedi, M. L. Subramanian, D. Husain, E. B. Feinberg, S. Ness; Evaluating the Efficacy of Preoperative Intravitreal Bevacizumab in Diabetic Tractional Retinal Detachment Repair: A Retrospective Case Series Study. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4235.
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To evaluate the effect of preoperative intravitreal bevacizumab (IVB) injection on intraoperative variables and postoperative outcomes in the treatment of diabetic traction retinal detachment (TRD).
This is a retrospective chart review of patients with diabetic TRD who underwent primary TRD surgery at Boston Medical Center. Patients in the IVB group received intravitreal bevacizumab injections (1.25mg/0.05cc) two to ten days prior to pars plana vitrectomy (PPV). Surgical reports and perioperative clinical visits were analyzed. The primary endpoint of the study was the presence of recurrent TRD at any time in the post-operative period. Secondary endpoints include presence of intraoperative or postoperative vitreous hemorrhage, postoperative visual acuity (VA) and recurrent proliferative diabetic retinopathy.
Twenty-four eyes met inclusion criteria. Eighteen eyes underwent traditional TRD repair with 20-gauge PPV and six eyes received preoperative IVB prior to TRD repair. All patients had type 2 diabetes; the non-IVB group had a greater percentage of patients with DM>20 years’ duration (70% vs. 50%). However, only 20% of each group had poor glycemic control (HbA1C>10%). The age, race, and gender of each group was similar. Pre-operative ocular characteristics were also closely matched between the non-IVB vs. IVB groups with a similar percentage of eyes with TRD involving the macula (72% vs. 83%), prior PRP (89% vs. 83%), pre-operative vitreous hemorrhage (50% vs. 33%). The post-operative one-month VA was significantly better in the non-IVB group (logMAR 1.39 vs. 2.5, p=0.049); however, the pre-operative VA was also better in this group (logMAR 1.10 vs. 1.97, p=0.20). At 3, 6, and 12-months, there was no significant difference in VA between the two groups. The non-IVB group had a substantially higher incidence of intraoperative (5% vs. 0%) and post-operative day one vitreous hemorrhage (11% vs. 0%). The rates of recurrent TRD were not statistically different between the two groups (28% vs. 33%).
This case series review of 24 eyes undergoing PPV for diabetic TRD repair shows no difference in the rate of recurrent diabetic TRD between those with pre-operative IVB and those without pre-operative IVB. However, there is significant improvement in the rates of intraoperative and post-operative day one vitreous hemorrhage in patients treated with preoperative IVB. Further studies with larger sample sizes are needed for confirmation of these findings.
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