Preop anti-VEGF shows little effect on vitrectomy for dense vitreous hemorrhage

Retina. 2011;31(7):1254-1260.

Preoperative intravitreal injection of bevacizumab may have no significant effect on the facilitation of vitrectomy for dense diabetic vitreous hemorrhage or the early postoperative course, a study found.

"Preoperative injection of bevacizumab in diabetic patients with dense vitreous hemorrhage did not indicate a statistically significant difference between the injection and the control groups regarding intraoperative bleeding, iatrogenic break formation, or the need for endodiathermy. However, there was a trend toward fewer intraoperative events in the injection group, especially those with complete [panretinal photocoagulation]," the authors wrote.

Eighteen patients were randomly assigned to receive 1.25 mg of Avastin (bevacizumab, Genentech) roughly 1 week prior to vitrectomy, and 17 patients served as controls. Mean follow-up was 8.1 months.

Average complexity scores and proliferative diabetic vitreoretinopathy stages for the two groups were similar, as were anatomical outcomes and visual acuity at 3 months and final follow-up. Mean bleeding score was 1.05 in the bevacizumab group and 1.76 in the control group. Endodiathermy applications and break formations were 0.44 vs. 0.52 and 0.22 vs. 0.29 in the injection and control groups, respectively.

The researchers observed a link between bevacizumab and increased intraoperative bleeding, break formation and need for endodiathermy in patients without prior complete laser therapy, but the association was statistically insignificant.

The authors acknowledged study limitations including small sample size, insufficient follow-up, lack of ultrasonographic evaluation of induction or progression of tractional retinal detachment, and the fact that three different surgeons performed vitrectomy. They recommended that a larger, prospective, randomized study be undertaken.