June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Long Term Outcomes of Pre-operative Bevacizumab use in Diabetic Retinopathy patients needing Vitrectomy: A TriNetX Analysis
Author Affiliations & Notes
  • Erin Flynn
    Ophthalmology, George Washington University Medical Faculty Associates, Washington, District of Columbia, United States
  • Daniel Akinbolue
    The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States
  • Haig Pakhchanian
    The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States
  • Rahul Raiker
    West Virginia University School of Medicine, West Virginia, United States
  • Heeyah Song
    Ophthalmology, George Washington University Medical Faculty Associates, Washington, District of Columbia, United States
  • Monica Dalal
    Ophthalmology, George Washington University Medical Faculty Associates, Washington, District of Columbia, United States
  • Footnotes
    Commercial Relationships   Erin Flynn None; Daniel Akinbolue None; Haig Pakhchanian None; Rahul Raiker None; Heeyah Song None; Monica Dalal None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 2199 – F0262. doi:
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      Erin Flynn, Daniel Akinbolue, Haig Pakhchanian, Rahul Raiker, Heeyah Song, Monica Dalal; Long Term Outcomes of Pre-operative Bevacizumab use in Diabetic Retinopathy patients needing Vitrectomy: A TriNetX Analysis. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2199 – F0262.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To determine if there were differences in long term outcomes in patients requiring pars plana vitrectomy (PPV) for diabetic retinopathy (DR) with preoperative bevacizumab intravitreal injection versus without.

Methods : This retrospective cohort study utilized data from TriNetX (Cambridge, MA, USA), a federated electronic health records research network comprising 56 large health organizations in the United States. Patients who underwent PPV for DR were identified by CPT code and stratified by preoperative bevacizumab injection and no preoperative bevacizumab injection. Patients were matched for age, gender, and medical comorbidities (essential hypertension, diabetes mellitus, cerebrovascular disease, heart failure, nicotine dependence, alcohol related disorders, and body mass index). Primary outcomes measured over a year after the procedure included: vitreous hemorrhage (VH), choroidal hemorrhage, cystoid macular degeneration (CME), puckering of macula, glaucoma, cataract, dry eye syndrome (DES), central retinal vein occlusion, central retinal artery occlusion, vitreous opacities, ptosis, dislocation of lens, endophthalmitis, and retinal vascular occlusions. These long-term outcomes were compared between the cohorts after propensity score matching using logistic regression.

Results : A total of 6,810 patients were analyzed with 3,405 in each cohort after propensity matching. The preoperative bevacizumab cohort showed a significantly greater risk of developing VH (RR, 1.72; 95% CI, 1.36-2.17), Cataract (RR, 1.32; 95% CI, 1.14-1.53) and DES (1.66; 95% CI,1.29-2.14). The cohort without preoperative bevacizumab injection had a slightly greater risk of developing CME (RR, 1.36; p=0.034, 1.02-1.81 ) and increased risk of dislocation of lens (RR, 2.22; p=0.002 ,1.33-3.70 ). No other significant differences were found between the cohorts.

Conclusions : Preoperative treatment with bevacizumab before PPV for DR is a technique utilized in an attempt to lower intraocular VEGF levels and counter proliferation for the procedure. In this study, preoperative treatment of bevacizumab significantly increased risk of vitreous hemorrhage and cataract. However, lack of preoperative bevacizumab injection was associated with a more frequent occurrence of CME. This study illustrates that using bevacizumab preoperatively may have outcomes over a year after the operation.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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