May 2007
Volume 48, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2007
Development or Progression of Tractional Retinal Detachment After Intravitreal Bevacizumab (Avastin) in Severe Proliferative Diabetic Retinopathy
M. Maia; H. W. Flynn, Jr.; M. Saravia; R. L. Avery; L. Wu; M. E. Farah; M. H. Berrocal; J. G. Sanchez; J. Arevalo; Pan American Collaborative Retina Study Group (PACORES)
Author Affiliations & Notes
  • M. Maia
    Ophthalmology, UNIFESP, Sao Paulo, Brazil
  • H. W. Flynn, Jr.
    Retina and Vitreous Service, Bascon Palmer Eye Institute, Miami, Florida
  • M. Saravia
    Ophthalmology, Hospital Univ. Austral, Buenos Aires, Argentina
  • R. L. Avery
    Ophthalmology, California Retina and Researh Foundation, Santa Barbara, California
  • L. Wu
    Ophthalmology, Instituto de Cirurgia Ocular, San Jose, Costa Rica
  • M. E. Farah
    Ophthalmology, UNIFESP, Sao Paulo, Brazil
  • M. H. Berrocal
    Ophthalmology, University of Puerto Rico, San Juan, Puerto Rico
  • J. G. Sanchez
    Retina and Vitreous Service, Clinica Oftalmolagica Centro Caracas, Caracas, Venezuela
  • J. Arevalo
    Retina and Vitreous Service, Clinica Oftalmolagica Centro Caracas, Caracas, Venezuela
  • Pan American Collaborative Retina Study Group (PACORES)
    Ophthalmology, UNIFESP, Sao Paulo, Brazil
  • Footnotes
    Commercial Relationships M. Maia, None; H.W. Flynn, None; M. Saravia, None; R.L. Avery, None; L. Wu, None; M.E. Farah, None; M.H. Berrocal, None; J.G. Sanchez, None; J. Arevalo, None.
  • Footnotes
    Support Supported in part by the Foundation for Science Support from Sao Paulo (FAPESP), São Paulo - SP, Brazil and The Arevalo-Coutinho Foundation for Research in Ophthalmology, Caracas, Venezuela
Investigative Ophthalmology & Visual Science May 2007, Vol.48, 1411. doi:
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      M. Maia, H. W. Flynn, Jr., M. Saravia, R. L. Avery, L. Wu, M. E. Farah, M. H. Berrocal, J. G. Sanchez, J. Arevalo, Pan American Collaborative Retina Study Group (PACORES); Development or Progression of Tractional Retinal Detachment After Intravitreal Bevacizumab (Avastin) in Severe Proliferative Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1411.

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Abstract

Purpose:: To report the development or progression of tractional retinal detachment (TRD) after the injection of intravitreal (IVT) bevacizumab (Avastin) as an adjuvant to vitrectomy for the management of severe proliferative diabetic retinopathy (PDR).

Methods:: Interventional multicenter retrospective study at 7 centers from 6 countries. Clinical charts of patients who experienced the development or progression of TRD after an IVT injection of 1.25 mg or 2.5 mg of bevacizumab before vitrectomy for the management of PDR were reviewed. Ten eyes out of 211 IVT injections (4.7%) that developed or had progression of TRD were identified. All eyes had PDR refractory to panretinal photocoagulation (PRP). Statistical analysis was performed utilizing a Student t-test.

Results:: Patients had a mean age of 36.2 years old (range: 22 to 56 years). Nine patients had diabetes mellitus (DM) type 1, one DM type 2, treated with insulin for glycemic control. However, all patients showed elevated glycosylated hemoglobin (mean: 10.9%). Time from injection to TRD had a mean of 13.2 days (range: 3 to 31 days). The mean baseline best-correct visual acuity (BCVA) was LogMAR = 0.7 (range: 0.3 to 1.3).In eyes with TRD development or progression, the mean BCVA was LogMAR = 2.2 (range: 1.0 to 2.6) (p < 0.0001). Eight eyes underwent surgical intervention, and two patients refused surgery. Final mean BCVA after surgery was LogMAR = 1.0 (range: 0.2 to 2.0), a statistically significant change compared to TRD BCVA (p < 0.0001). Final BCVA after vitrectomy demonstrated that 2 (25%) eyes remained stable, 3 (37.5%) eyes improved two or more ETDRS lines, and 3 (37.5%) eyes decreased two or more ETDRS lines.

Conclusions:: TRD in PDR may occur or progress after IVT bevacizumab but is infrequent (4.7%). TRD in PDR may occur by natural history, fast neovascular involution with fibrosis contraction after IVT bevacizumab injection or an unknown effect of the drug. Poorly controlled DM associated with elevated HbA1c, insulin administration, and longer time between IVT bevacizumab and vitrectomy seem to be risk factors.

Keywords: diabetic retinopathy • injection • drug toxicity/drug effects 
© 2007, The Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Permission to republish any abstract or part of an abstract in any form must be obtained in writing from the ARVO Office prior to publication.
Copyright © 2015 Association for Research in Vision and Ophthalmology.
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