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A. G. Sharma, T. H. Mahmoud; Value of Preoperative Intravitreous Injection of Bevacizumab (Avastin) in Diabetic Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1417.
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To study the characteristics and outcomes of patients undergoing diabetic pars plana vitrectomy (PPV) with and without preoperative intravitreous injection of Bevacizumab (Avastin).
A retrospective chart review of patients who underwent diabetic PPV was conducted. Analysis included preoperative visual acuity (VA), phakic status, indication of PPV, panretinal photocoagulation (PRP), and anticoagulant use; operative factors as duration of PPV and complications; and postoperative functional and anatomical outcomes. Eyes were divided into 2 groups, one with preoperative intravitreous injection of Avastin (IVA), and one without the use of IVA.
PPV was performed on 21 eyes of 19 patients. IVA was given preoperatively in 10 of 21 eyes (47%). Mean age of the group without IVA was 51 years, with 6 males and 5 females. Preoperative VA ranged between 20/100 and hand motion (HM). Eight eyes were phakic, and 3 were pseudophakic. Six presented with non-clearing vitreous hemorrhage (NCVH), 1 with pre-macular hemorrhage (PMH), and 4 with traction macular detachment (TMD), with preoperative PRP in 8 eyes, and anticoagulant use in 3 patients. Mean surgical time was 128 minutes. Mean postoperative VA ranged from 20/30 to 20/400 with a mean follow up of 4.5 months. One patient was reoperated on for macular detachment secondary to a consecutive rhegmatogenous element. Patients in the group with preoperative IVA had a mean age of 54 years, with 7 males and 3 females. Preoperative VA ranged between 20/30 and HM. Eight eyes were phakic, and 2 were pseudophakic. Two presented with NCVH, 1 with PMH, and 7 with TMD, with preoperative PRP in 9 eyes, and anticoagulant use in 5 patients. Avastin was injected between 3 days and 4 weeks prior to PPV with a mean of 8 days. Mean surgical time was 127 minutes. Mean postoperative VA ranged from 20/25 to HM with a mean follow up of 2 months. Additional information will be presented with longer follow up.
Intravitreous injection of Bevacizumab is commonly used prior to diabetic vitrectomy, particularly in very severe proliferative diabetic retinopathy with traction macular detachment. It helps decrease vascular engorgement in areas of fibrovascular proliferation, facilitating bimanual dissection and reducing intraoperative bleeding, and surgical times. It may be valuable in patients who cannot stop preoperative anticoagulants. Ideal timing of preoperative IVA would still need to be determined to take advantage of the anti-VEGF effect. Patients with NCVH and PMH, not on anticoagulants would not necessarily benefit from preoperative IVA.
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