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Preop bevacizumab improves visualization in complicated diabetic vitrectomies
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HONG KONG — Preoperative injections of bevacizumab seem to improve results of diabetic vitrectomy procedures, one surgeon said here.
"Preoperative Avastin (bevacizumab, Genentech) appears to improve visual outcomes, decrease postoperative complications and reduce postoperative procedures in this group of patients. It appears particularly useful in the more complex cases," Maria Berrocal, MD, said during her presentation at the World Ophthalmology Congress.
Dr. Berrocal presented a prospective, randomized, unmatched study of 82 eyes of 80 patients. Of those patients, 41 were pretreated with 1.25 mg of Avastin, 4 days to 8 weeks before vitrectomy.
Both groups were made up of patients with vitreous hemorrhage, traction retinal detachment and rhegmatogenous retinal detachment who had similar baseline characteristics.
"Looking at the different etiologies, we saw better vision in the Avastin group, but it was more notable in the more complicated cases," she said.
Final analysis showed 76% of eyes treated with bevacizumab had improved visual acuity, compared with 53% in the vitrectomy-only group. Mean visual acuity was 20/100 in the bevacizumab group and 20/400 in the vitrectomy group.
Postoperative complications also showed more residual vitreous hemorrhage and more bleeding in the vitrectomy-only group in all cases, Dr. Berrocal said. When looking at postoperative procedures, 69% of the vitrectomy-only group needed additional treatments, she said.
"These surgeries were very challenging in the past, and they're still challenging now, but the biggest problem was controlling bleeding during the surgery," Dr. Berrocal said. "You can just cut all these membranes without significant bleeding."
"What's interesting about these cases is that they become fairly avascular," she said. "It allows us to basically do these surgeries in a much simpler way than we used to."
Dr. Berrocal said there are still unanswered questions regarding timing of the preoperative injection, whether there is a role of postoperative injections and any unknown complications of bevacizumab.