Anterior Retinal Cryotherapy and Intravitreal Injection of Bevacizumab in the Treatment of Nonclearing Vitreous Hemorrhage in Proliferative Diabetic Retinopathy

Abstract

To evaluate the efficacy of intravitreal bevacizumab (IVB) injection combined with anterior retinal cryotherapy (ARC) in the treatment of proliferate diabetic retinopathy (PDR) with vitreous hemorrhage (VH). A retrospective case controlled study was performed on 67 cases (67 patients) with PDR and persistent VH obscuring the fundus detail for ≧3 weeks. The follow-up period was ≧6 months. Cases with extensive vitreo-retinal adhesion by ultrasonography were excluded. In the study group, transconjunctival ARC (a total of 12 spots) followed by IVB 1.25 mg was performed in the same setting; in the control group, only IVB was given. Panretinal photocoagulation was performed when possible. Repeated IVB was performed in both groups if VH persisted for >4 weeks following the initial treatment. Vitrectomy was performed if VH showed no improvement for 12 to 16 weeks. The vitreous clear-up time (VCUT) in the posterior pole and the rate of vitrectomy were compared between the 2 groups. In the study group (n=35), second treatment was required in 7 out of 35 patients (20.0%). Vitrectomy was performed in 5 (14.3%) patients. In the control group (n=32), 8 out of 32 eyes (25.0%) underwent second injection. Four eyes (12.5%) had vitrectomy within the follow-up time. VCUT in the study and the control group was 6.9±8.7 weeks and 13.0±9.3 weeks respectively (P=0.003). Combined treatment of ARC and IVB is associated with more rapid clearing of VH in eyes with PDR compared with IVB alone.