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Anti-VEGF therapy, microincision vitrectomy may be beneficial in treating diabetic traction retinal detachment
Ophthalmology. 2009;116(5):927-938.
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Combined therapy with intravitreal bevacizumab and surgical management with small-gauge instruments may be beneficial for treatment of severe proliferative diabetic retinopathy.
In the study, the combined protocol induced comparable anatomic success in the management of traction retinal detachment secondary to proliferative diabetic retinopathy when compared with standard 20-gauge pars plana vitrectomy. The surgical component, using either 25- or 23-gauge instrumentation, was shorter in duration than 20-gauge pars plana vitrectomy, and fewer complications were noted.
The use of smaller, transconjunctival incisions with 23- or 25-gauge instrumentation for vitrectomy has several theoretical benefits, the authors wrote, including reduced surgically induced trauma, astigmatism and conjunctival scarring. As well, the microincision techniques may be more amenable to repeated vitrectomy, which might be necessary for management of ophthalmic complications secondary to chronic diabetes. The addition of Avastin (bevacizumab, Genentech) in the management of proliferative diabetic retinopathy to reduce neovascularization before surgical intervention may further reduce retinal ischemia, both peri- and postoperatively.
In the study, success of surgery was 95% in 38 eyes of 33 patients who underwent the combined protocol, which did not differ from the 91% seen in 33 eyes of 26 patients in the 20-gauge pars plana vitrectomy group. However, surgical time, rate of intraoperative bleeding and rate of visual improvement were all improved in the combined group.