Abstract
Purpose :
Preoperative intravitreal Bevacizumab (Avastin) injections (IVA) have recently been shown to be
effective in reducing post-operative vitreous hemorrhage (VH) in patients undergoing pars
plana vitrectomy (PPV) for complicated proliferative diabetic retinopathy (PDR) with tractional
retinal detachments (TRD). However, the effect of preoperative IVA in cases of non-complicated
PDR (without TRD) is unclear. The purpose of this study is to determine the effect of
preoperative IVA in reducing postoperative VH in non-complicated PDR patients undergoing
PPV for non-clearing VH.
Methods :
A retrospective review of 100 patients undergoing diabetic PPV was performed. Patients
undergoing PPV for non-complicated PDR and non-clearing VH were included in the study,
while those with TRDs noted preoperatively or intraoperatively were excluded. Group A
received an IVA (1.25mg per 0.05cc) prior to PPV while Group B did not. Surgeries were
performed by two surgeons. Measured endpoints included ETDRS VA and incidence of post-
operative VH. Measured variables included smoking status, use of blood thinners, insulin
dependency, and hemoglobin A1c (HbA1c).
Results :
A total of 67 eyes met inclusion criteria (Group A: 37/67 (55%); Group B: 30/67 (45%)). Baseline
HbA1c was 8.3 (6.5-12) for Group A and 8.1 (5.1-11) for Group B. Mean time of IVA prior to PPV
was 22 days. At month 1 postop, 3/37 (8%) eyes in Group A and 1/30 (3%) eyes in Group B
had a recurrent VH. However, no statistical difference was seen in postop 1 and 3 month VA or
in postop VH incidence between Groups A and B. In addition, no statistically significant
correlation was found for HbA1c or the other variables studied.
Conclusions :
In contrast with complicated PDR, preoperative IVA did not have a significant effect in
improving postop VA or reducing postop VH incidence in non-complicated PDR patients. Given
the small risk of infection, bleeding, intraocular pressure rise and inflammation associated with
intravitreal injections, our results suggest that the role of preoperative IVA in non-complicated
PDR cases is limited and warrants additional prospective study.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.