Can an Intraoperative Bevacizumab Injection Prevent Recurrent Postvitrectomy Diabetic Vitreous Hemorrhage?

Abstract

To evaluate the recurrence of vitreous hemorrhage (VH) in patients treated with intravitreal bevacizumab (IVB) injection (2.5 mg/0.1 mL) intraoperatively at the end of vitrectomy for treatment of diabetic nonclearing VH. A prospective pilot study of 30 eyes of 28 consecutive diabetic patients who underwent pars plana vitrectomy and IVB injection intraoperatively at the end of vitrectomy was performed. The amount of VH was graded with slit lamp biomicroscopy by three masked retinal specialists from grade 0 to grade 3. Main outcome measures were rate of recurrence of the VH, improvement in visual acuity, incidence of cataract formation, and postoperative complications through a follow-up of 6 months. The percentage of severe recurrent VH with no fundus details (grade 3) was 7%, 13%, 27%, and 30%, respectively, at 7 days and 1-, 3-, and 6-month follow-up. At 6-month followup, the best-corrected visual acuity improved from 1.00 to 0.4 logMAR (p=0.01) in 21 out of 30 eyes (70%). Nine out 20 (40%) phakic patients developed cataract during the follow-up period, and 7 (31%) of them underwent cataract surgery. The study suggests that intravitreal bevacizumab injection cannot prevent rebleeding in eyes undergoing pars plana vitrectomy for treatment of diabetic vitreous hemorrhage.