Skip to main content

Advertisement

SpringerLink
Log in

Six-month visual outcome after pars plana vitrectomy in proliferative diabetic retinopathy with or without a single preoperative injection of intravitreal bevacizumab

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

The purpose of this study is to evaluate the effect of a single preoperative injection of intravitreal bevacizumab (IVB) on visual outcome in patients undergoing pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). Retrospective chart review of patients who underwent PPV for PDR and followed for at least 6 months after surgery. Patients who received a single IVB injection (1.25 mg in 0.05 ml) preoperatively were assigned to group A. Those who did not receive IVB were assigned to group B. The primary outcome measure was visual outcome at 6-month follow-up. The secondary outcomes were postoperative complications. At 6 months, visual acuity improved by at least 0.3 logMAR units in 70 (74.5 %) of the 94 eyes in group A versus 46 (52.9 %) of the 87 eyes in group B (p = 0.002). Postoperative vitreous hemorrhage occurred significantly less frequently in group A (6 eyes, 6.4 %) than in group B (14 eyes, 16.1 %; p = 0.037). The incidence of other postoperative complications did not differ significantly between the two groups. Preoperative use of bevacizumab improved the 6-month visual outcome in patients undergoing PPV for PDR and significantly reduced the occurrence of postoperative vitreous hemorrhage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Aiello LP, Gardner TW, King GL, Blankenship G, Cavallerano JD, Ferris FL 3rd et al (1998) Diabetic retinopathy. Diabetes Care 21:143–156

    CAS  PubMed  Google Scholar 

  2. Flynn HW Jr, Chew EY, Simons BD, Barton FB, Remaley NA, Ferris FL 3rd (1992) Pars plana vitrectomy in the early treatment diabetic retinopathy study. ETDRS report number 17. Ophthalmology 99:1351–1357

    PubMed  Google Scholar 

  3. The Diabetic Retinopathy Vitrectomy Study Research Group (1990) Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy: four-year results of a randomized trial. Diabetic retinopathy vitrectomy study report number 5. Arch Ophthalmol 108: 958–964

    Google Scholar 

  4. The Diabetic Retinopathy Vitrectomy Study Research Group (1988) Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Clinical application of results of a randomized trial. DRVS report 4. Ophthalmology 95:1321–1334

    Google Scholar 

  5. Oyakawa RT, Schachat AP, Michels RG, Rice TA (1983) Complications of vitreous surgery for diabetic retinopathy. I. Intraoperative complications. Ophthalmology 90:517–521

    CAS  PubMed  Google Scholar 

  6. Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST et al (1994) Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 331:1480–1487

    Article  CAS  PubMed  Google Scholar 

  7. Kramer I, Lipp HP (2007) Bevacizumab, a humanized antiangiogenic monoclonal antibody for the treatment of colorectal cancer. J Clin Pharm Ther 32:1–14

    Article  CAS  PubMed  Google Scholar 

  8. Chen E, Park CH (2006) Use of intravitreal bevacizumab as a preoperative adjunct for tractional retinal detachment repair in severe proliferative diabetic retinopathy. Retina 26:699–700

    Article  PubMed  Google Scholar 

  9. Avery RL (2006) Regression of retinal and iris neovascularization after intravitreal bevacizumab (Avastin) treatment. Retina 26:352–354

    Article  PubMed  Google Scholar 

  10. Spaide RF, Fisher YL (2006) Intravitreal bevacizumab (Avastin) treatment of proliferative diabetic retinopathy complicated by vitreous hemorrhage. Retina 26:275–278

    Article  PubMed  Google Scholar 

  11. Mason JO 3rd, Albert MA Jr, Mays A, Vail R (2006) Regression of neovascular iris vessels by intravitreal injection of bevacizumab. Retina 26:839–841

    Article  PubMed  Google Scholar 

  12. Jorge R, Costa RA, Calucci D, Cintra LP, Scott IU (2006) Intravitreal bevacizumab (Avastin) for persistent new vessels in diabetic retinopathy (IBEPE study). Retina 26:1006–1013

    Article  PubMed  Google Scholar 

  13. Goff MJ, Johnson RN, McDonald HR, Ai E, Jumper JM, Fu A (2007) Intravitreal bevacizumab for previously treated choroidal neovasculariztion from age-related macular degeneration. Retina 27:432–438

    Article  PubMed  Google Scholar 

  14. Lo WR, Kim SJ, Aaberg TM Sr, Bergstrom C, Srivastava SK, Yan J et al (2009) Visual outcomes and incidence of recurrent vitreous hemorrhage after vitrectomy in diabetic eyes pretreated with bevacizumab (Avastin). Retina 29:926–931

    Article  PubMed  Google Scholar 

  15. Yeoh J, Williams C, Allen P, Buttery R, Chiu D, Clark B et al (2008) Avastin as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series. Clin Exp Ophthalmol 36:449–454

    Google Scholar 

  16. El-Batarny AF (2008) Intravitreal bevacizumab as an adjunctive therapy before diabetic vitrectomy. Clin Ophthalmol 2:709–716

    CAS  PubMed  Google Scholar 

  17. Rizzo S, Genovesi-Ebert F, Di Bartolo E, Vento A, Miniaci S, Williams G (2008) Injection of intravitreal bevacizumab (Avastin) as a preoperative adjunct before vitrectomy surgery in the treatment of severe proliferative diabetic retinopathy (PDR). Graefes Arch Clin Exp Ophthalmol 246:837–842

    Article  CAS  PubMed  Google Scholar 

  18. Ahn J, Woo SJ, Chung H, Park KH (2011) The effect of adjunctive intravitreal bevacizumab for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy. Ophthalmology 118:2218–2226

    Article  PubMed  Google Scholar 

  19. Farahvash MS, Majidi AR, Roohipoor R, Ghassemi F (2011) Preoperative injection of intravitreal bevacizumab in dense diabetic vitreous hemorrhage. Retina 31:1254–1260

    Article  CAS  PubMed  Google Scholar 

  20. Pokroy R, Desai UR, Du E, Li Y, Edwards P (2011) Bevacizumab prior to vitrectomy for diabetic tractional retinal detachment. Eye 25:989–997

    Article  CAS  PubMed  Google Scholar 

  21. Zhao LQ, Zhu H, Zhao PQ, Hu YQ (2011) A systematic review and meta-analysis of clinical outcomes of vitrectomy with or without intravitreal bevacizumab pretreatment for severe diabetic retinopathy. Br J Ophthalmol 95:1216–1222

    Article  PubMed  Google Scholar 

  22. Holladay JT (1997) Proper method for calculating average visual acuity. J Refract Surg 13:388–391

    CAS  PubMed  Google Scholar 

  23. Blankenship GW (1981) Stability of pars plana vitrectomy results for diabetic retinopathy complications: a comparison of 5 year and 6 month postvitrectomy findings. Arch Ophthalmol 99:1009–1012

    Article  CAS  PubMed  Google Scholar 

  24. Oshima Y, Sakaguchi H, Gomi F, Tano Y (2006) Regression of iris neovascularization after intravitreal injection of bevacizumab in patients with proliferative diabetic retinopathy. Am J Ophthalmol 142:155–158

    Article  CAS  PubMed  Google Scholar 

  25. Isaacs T, Barry C (2006) Rapid resolution of severe disc new vessels in proliferative diabetic retinopathy following a single intravitreal injection of bevacizumab. Clin Exp Ophthalmol 34:802–805

    Article  Google Scholar 

  26. Meredith TA (1994) Current indications for diabetic vitrectomy. In: Lewis H, Ryan SJ (eds) Medical and surgical retina: advances, controversies and management. Mosby, St. Louis, pp 290–303

    Google Scholar 

  27. [DRVS] Diabetic Retinopathy Vitrectomy Study Research Group (1988) Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomized trial, diabetic vitrectomy study report 3. Ophthalmology 95:1307–1320

    Google Scholar 

  28. Thompson JT, Auer CL, de Bustros S, Michels RG, Rice TA, Glaser BM (1986) Prognostic indicators of success and failure in vitrectomy for diabetic retinopathy. Ophthalmology 93:290–295

    CAS  PubMed  Google Scholar 

  29. Ahmadieh H, Shoeibi N, Entezari M, Monshizadeh R (2009) Intravitreal bevacizumab for prevention of early postvitrectomy hemorrhage in diabetic patients: a randomized clinical trial. Ophthalmology 116:1943–1948

    Article  PubMed  Google Scholar 

  30. Schachat AP, Oyakawa RT, Michels RG, Rice TA (1983) Complications of vitreous surgery for diabetic retinopathy. II. Postoperative complications. Ophthalmology 90:522–530

    CAS  PubMed  Google Scholar 

  31. Novak M, Rice T, Michels R (1984) Vitreous hemorrhage after vitrectomy for diabetic retinopathy. Ophthalmology 91:1485–1489

    CAS  PubMed  Google Scholar 

  32. Blankenship GW (1986) Management of vitreous cavity hemorrhage following pars plana vitrectomy for diabetic retinopathy. Ophthalmology 93:39–44

    CAS  PubMed  Google Scholar 

  33. Tolentino FI, Cajita VN, Gancayco T, Skates S (1989) Vitreous hemorrhage after closed vitrectomy for proliferative diabetic retinopathy. Ophthalmology 96:1495–1500

    CAS  PubMed  Google Scholar 

  34. Liggett PE, Lean JS, Barlow WE, Ryan SJ (1987) Intraoperative argon endophotocoagulation for recurrent vitreous hemorrhage after vitrectomy for diabetic retinopathy. Am J Ophthalmol 103:146–149

    CAS  PubMed  Google Scholar 

  35. Lee MS, Abrams GW (2001) Membrane dissection in proliferative diabetic retinopathy. In: Peyman GA, Ameffert S, Conway MD et al (eds) Vitreoretinal surgical techniques. Martin Dunitz Ltd., London, pp 251–266

    Google Scholar 

  36. Oshima Y, Shima C, Wakabayashi T, Kusaka S, Shiraga F, Ohji M et al (2009) Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment. Ophthalmology 116:927–938

    Article  PubMed  Google Scholar 

  37. Romano MR, Gibran SK, Marticorena J, Wong D, Heimann H (2009) Can a preoperative bevacizumab injection prevent recurrent postvitrectomy diabetic vitreous hemorrhage? Eye 23:1698–1701

    Article  CAS  PubMed  Google Scholar 

  38. Beer PM, Wong S, Hammad AM, Falk NS, O’Malley MR et al (2006) Vitreous levels of unbound bevacizumab and unbound vascular endothelial growth factor in two patients. Retina 26:871–876

    Article  PubMed  Google Scholar 

  39. Arevalo JF, Maia M, Flynn HW Jr, Saravia M, Avery RL, Wu L et al (2008) Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy. Br J Ophthalmol 92:213–216

    Article  CAS  PubMed  Google Scholar 

  40. Helbig H, Kellner U, Bornfeld N, Foerster MH (1998) Rubeosis iridis after vitrectomy for diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 236:730–733

    Article  CAS  PubMed  Google Scholar 

  41. Kadonosono K, Matsumoto S, Uchio E, Sugita M, Akura J, Ohno S (2001) Iris neovascularization after vitrectomy combined with phacoemulsification and intraocular lens implantation for proliferative diabetic retinopathy. Ophthalmic Surg Lasers 32:19–24

    CAS  PubMed  Google Scholar 

  42. Torres-Soriano ME, Reyna-Castelán E, Hernández-Rojas M (2009) Tractional retinal detachment after intravitreal injection of bevacizumab in proliferative diabetic retinopathy. Retin Cases Brief Rep 3:70–73

    Article  Google Scholar 

  43. Scholda C, Rainer G, Kriechbaum K (2007) Preoperative intravitreal injection of bevacizumab in advanced proliferative diabetic retinopathy (abstract). Joint Congress of SOE/AAO June 9–12, 2007, Vienna, Austria, p 79

  44. El-Sabagh HA, Abdelghaffar W, Labib AM, Mateo C, Hashem TM, Al-Tamimi DM, Selim AA (2011) Preoperative intravitreal bevacizuamb use as an adjuvant to diabetic vitrectomy: histopathologic findings and clinical implications. Ophthalmology 118:636–641

    Article  PubMed  Google Scholar 

  45. Ishikawa K, Honda S, Tsukahara Y, Negi A (2009) Preferable use of intravitreal bevacizumab as a pretreatment for severe proliferative diabetic retinopathy. Eye 23:108–111

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Amod Gupta, Reema Bansal, Vishali Gupta & Mangat R. Dogra

Authors
  1. Amod Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Reema Bansal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vishali Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mangat R. Dogra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amod Gupta.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gupta, A., Bansal, R., Gupta, V. et al. Six-month visual outcome after pars plana vitrectomy in proliferative diabetic retinopathy with or without a single preoperative injection of intravitreal bevacizumab. Int Ophthalmol 32, 135–144 (2012). https://doi.org/10.1007/s10792-012-9541-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-012-9541-5

Keywords

Search

Navigation