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Intravitreal anti-VEGF may help manage recurrent vitreous hemorrhage

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LAS VEGAS — Intravitreal bevacizumab may be a useful adjunct for the management of recurrent vitreous hemorrhage in eyes that have undergone vitrectomy for proliferative diabetic retinopathy, a speaker said here.

 Recurrent vitreous hemorrhage affects about 20% of eyes after pars plana vitrectomy (PPV) for proliferative diabetic retinopathy, Mathew MacCumber, MD, PhD, told colleagues at the American Society of Retina Specialists meeting.

Mathew MacCumber

“Recurrent vitreous hemorrhage after PPV has been managed by observation, outpatient fluid-air exchange or repeat vitrectomy, including anterior hyaloidal dissection, supplemental laser or cryopexy and/or silicone oil,” MacCumber said.

Because intravitreal Avastin (bevacizumab, Genentech) can cause regression of retinal anterior segment neovascularization, MacCumber and colleagues examined its efficacy in treating recurrent vitreous hemorrhage, he said.

In a retrospective chart review, MacCumber and colleagues looked at 12 eyes of nine patients with recurrent postoperative vitreous hemorrhage after PPV for proliferative diabetic retinopathy that did not clear within 1 month. Patients underwent 20- or 23-gauge PPV with membrane removal to at least 4 disc diopters from the macula. Release of traction and retinal reattachment were achieved in all cases.

“Ten of 12 eyes were clear at the end of follow-up. Only one eye needed a repeat vitrectomy, and that was in the early postoperative period. And only one eye had fluid-air exchange,” MacCumber said.

• Disclosure: MacCumber is a consultant for Regeneron, Genentech, ThromboGenics, Allergan and Optos. He receives grant support from Genentech, Allergan, GlaxoSmithKline, Optos, ArcticDx and Sequenom.