329 Bevacizumab pré-opératoire dans le traitement chirurgical de la rétinopathie diabétique proliférante sévère

Abstract

To evaluate the safety and efficacy of intravitreal bevacizumab as a pre-operative surgical adjuvant in the treatment of severe proliferative diabetic retinopathy. 44 patients with severe proliferative diabetic retinopathy were assigned to intravitreal bevacizumab (group 2) or sham injections (group 1) three weeks before pars plana vitrectomy. Two groups were similar at baseline for surgical complexity score with on a well-defined 1 – 5 scale, to evaluate vitreous hemorrhage, iris neovascularization, prior retinal photocoagulation, morphological type of retinal detachment. Main outcome measures were safety and efficacy of surgery. To evaluate whether the pars plana vitrectomy was easier we recorded intra-operative bleeding during fibrovascular membrane peeling, use of endodiathermy, relaxing retinotomies or iatrogenic breaks, silicone oil tamponade and surgery time. The patients receveid intravitral injection of 0,05 ml containing 1,25 mg of bevacizumab three weeks before vitrectomy. Surgical intra-operative records of 22 patients of group 1 (without Bevacizumab) were intra-operative bleeding in 18 cases, use of endodiathermy in 13, relaxing retinotomies or iatrogenic breaks in 6, silicone oil tamponade in 9, mean surgical time 94 minutes. Surgical intra-operative records of 22 patients of group 2 (with bevacizumab) were intra-operative bleeding in 3 cases, use of endodiathermy in 1, relaxing retinotomies or intra-operative breaks in 1, silicone oil tamponade in 3, mean surgical time 69 minutes. Preoperative intravitreal bevacizumab is helpful in decreasing the vascularisation of fibrovascular membranes, thereby reducing the intra-operative bleeding and complications. It may serve to improve success of vitrectomy for patients with severe proliferative diabetic retinopathy.