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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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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).
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.
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.
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.
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