Abstract
Introduction: The purpose of this work is to study the efficacy of the preoperative intravitreal administration of bevacizumab as an adjunct to vitrectomy in patients with Proliferative Diabetic Retinopathy (PDR). Methods: This retrospective comparative study was performed on 118 eyes (118 patients) with proliferative diabetic retinopathy (PDR), which underwent vitrectomy surgery at the Department of Diabetic Eye Disease at Zarifa Aliyeva National Ophthalmology Centre (Baku, Azerbaijan) in 2015-2019. The main group (the bevacizumab group) included 48 eyes with PDR that received intravitreal administration of bevacizumab (Avastin; Genentech Inc., USA) within one week before vitrectomy; the control group included 70 eyes that did not receive a bevacizumab injection for at least 3 months before the vitrectomy. The minimum follow-up was 12 months. Results: In both groups, complete retinal attachment after primary vitrectomy was achieved in all eyes (100%). Clinically significant intraoperative haemorrhage was observed in the preoperative bevacizumab injection group in 31.2% and the control group- 51.4%, p = 0.030. The preoperative bevacizumab injection reduced the risk of clinically significant haemorrhage by 2.3 times and the need for endodiathermy by 2.7 times (p = 0.031 and p = 0.024, respectively). Early vitreous cavity haemorrhage was observed in 15.0% in the bevacizumab group and in 35.5% in the control group (p = 0.038). The preoperative injection of bevacizumab before vitrectomy reduced the risk of vitreous cavity haemorrhage in the early postoperative period by 3.0 times (p = 0.036). Conclusion: The preoperative use of bevacizumab as an adjunct to diabetic vitrectomy can help reduce the incidence of intraoperative and early postoperative vitreous cavity haemorrhage, which leads to better functional results in the early postoperative period. Over the long-term follow-up period, the effect of the preoperative bevacizumab injections decreases.
Highlights
The purpose of this work is to study the efficacy of the preoperative intravitreal administration of bevacizumab as an adjunct to vitrectomy in patients with Proliferative Diabetic Retinopathy (PDR)
The preoperative use of bevacizumab as an adjunct to diabetic vitrectomy can help to reduce the incidence of intraoperative and early postoperative vitreous cavity haemorrhage, which leads to better functional results in the early postoperative period
The BCVA improved in both groups, but the BCVA was significantly higher in the main group than in the control group (0.66 ± 0.39 and 0.89 ± 0.47, respectively, p = 0.008)
Summary
The purpose of this work is to study the efficacy of the preoperative intravitreal administration of bevacizumab as an adjunct to vitrectomy in patients with Proliferative Diabetic Retinopathy (PDR). Advances in vitreoretinal surgery technologies helped to improve anatomical and functional outcomes after vitrectomy in eyes with severe complications of Proliferative Diabetic Retinopathy (PDR) [2]. Despite the benefits of surgical treatment, the risk of severe intraoperative and postoperative complications, such as recurrent bleeding into the vitreous cavity, remains at a high level [3]. The source of early VH is the dispersion of the blood from the periphery to the centre of the vitreous cavity from dissected or trimmed fibrovascular membranes during surgery. The source of late VH is the neovascularization of the sclerotomies, vitreous base, iris, angle and retina. Various techniques have been suggested to reduce the risk of recurrent haemorrhages, including cryotherapy to the sclerotomies, gas or silicone oil endotamponade, with unproven efficacy [6 - 8]
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