Preop Bevacizumab No Help Against Vitreous Hemorrhage

July 22, 2011

By David Douglas

NEW YORK (Reuters Health) Jul 21 - Preoperative intravitreal injection of bevacizumab (Avastin) doesn't alter the incidence of postoperative vitreous hemorrhage after vitrectomy for proliferative diabetic retinopathy. However, intraoperative use may be beneficial, Korean researchers report.

Dr. Kyu Hyung Park told Reuters Health by email "To prevent the incidence of postoperative vitreous hemorrhage after vitrectomy in patients with diabetic retinopathy, many retinal surgeons have been injecting intraocular Avastin before surgery as an adjuvant without definite evidence."

"This article showed preoperative intraocular Avastin injection could not prevent postoperative vitreous hemorrhage, but intraoperative injection could in selected cases."

Dr. Park and colleagues at Seoul National University College of Medicine came to this conclusion after prospectively studying 107 eyes in 91 patients undergoing pars plana vitrectomy. Cases with long-term tamponade were excluded. The findings appear online July 2 in Ophthalmology.

The selected patients were randomized to intravitreal injection of bevacizumab 1 to 14 days before the procedure, injection at the end of surgery or to no injection.

At 4 weeks or less after surgery, the corresponding recurrence of vitreous hemorrhage was 22.2%, 10.8%, and 32.4%. Times to initial vitreous clearing were 26.4, 10.3, and 25.2 days.

Thus the intraoperative treatment group did significantly better than the control group in regard to vitreous hemorrhage and significantly better in time to vitreous clearing than the other 2 groups.

During follow-up, 19 eyes were excluded, 11 because of injection of intravitreal silicone oil or gas. Overall, best-corrected visual acuity didn't differ among groups at 6 months after surgery.

The investigators conclude that "there is no definite evidence to support the adjunctive use of preoperative intravitreal injection of bevacizumab to reduce postvitrectomy vitreous hemorrhage incidence in proliferative diabetic retinopathy." If adjunctive treatment "is considered, intraoperative administration may be the better option."


Ophthalmology 2011.


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