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L. M. Suarez Tata, M. Suarez-Tata, J. L. Guerrero-Naranjo, J. Sanchez, J. Arevalo; Intravitreal Bevacizumab (Avastin) as an Adjuvant to Vitrectomy With Silicone Oil Tamponade in Severe Proliferative Diabetic Retinopathy (PDR): Anatomic and Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5040.
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To describe and analyze the anatomic findings, complications, and visual outcomes in patients after intravitreal (IVT) bevacizumab (Avastin) as an adjuvant to pars plana vitrectomy (PPV) with silicone oil (SO) tamponade in severe proliferative diabetic retinopathy (PDR).
Prospective, non-comparative, interventional study. Eleven eyes of 9 patients (mean age: 50.2 years; range: 35 to 72 years) with severe PDR characterized by fibrovascular proliferation, preretinal and/or vitreous hemorrhage, and tractional retinal detachment involving or not the macula participated in this study. The study was approved by an Institutional Review Board. All patients signed an informed consent and were operated on after IVT bevacizumab (2.5 mg) as an adjuvant to PPV several days (mean: 26 days; range: 7 to 120 days) before surgery and immediately after fluid-air exchange. Complete ophthalmologic evaluation was performed before and after surgery. Best-corrected visual acuity (BCVA) measurements were made using ETDRS charts on baseline and at days 1, 4, 7, 15, 30, 60 and 90 after vitrectomy. SO tamponade was used in all cases. Statistical analysis was performed utilizing a Student t-test.
Anatomical success was obtained in 100% cases with complete reattachment of the retina with a minimum follow-up of 3 months (mean: 4.2 months; range: 3.5 to 6 months). The mean baseline best-correct visual acuity (BCVA) was LogMAR = 1.8 (range: 1 to 2.3). Final mean BCVA after surgery was LogMAR = 0.96 (range: 0 to 2.3) (p < 0.0001). BCVA improved three or more ETDRS lines (doubling of the visual angle) in nine eyes (81.8%) and there was no change in two eye 18.2%). None of the eyes lost BCVA after the procedure. No ocular or systemic adverse events have been observed.
Successful anatomic and visual outcomes at 3 months suggest that using IVT injection of bevacizumab several weeks before surgery, and after PPV with SO can be very useful in the management of severe PDR. IVT bevacizumab provided reduction of retinal and iris neovascularization, facilitated the surgical procedure, reduced the risk of intraoperative bleeding, and resulted in improvement or stability of BCVA in all eyes. Further studies and longer follow up are needed to confirm our findings.
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