Bevacizumab Pretreatment in Vitrectomy for Severe Proliferative Diabetic Retinopathy

嚴重增殖性糖尿病視網膜病變於玻璃體切除手術前玻璃體內注射癌思停

王嘉康(Jia-Kang Wang)

《中華民國眼科醫學會雜誌》 49卷4期 (2010/12) Pp. 562-569

https://doi.org/10.30048/ACTASOS.201012.0007

摘要

Background and Objective: To investigate the short-term clinical outcome of intravitreal bevacizumab (IVB) pretreatment in patients with severe proliferative diabetic retinopathy (PDR) requiring vitrectomy.
Materials and Methods: We enrolled 28 eyes of 24 patients with PDR pretreated by IVB (1.25 mg/0.05 ml) for an average of 9.2 days before vitrectomy. The patients were divided into three groups: Group 1-vitrectomy alone (8 eyes), Group 2-vitrectomy with C3F8 tamponade (7 eyes), and Group 3-vitrectomy and silicone oil infusion (13 eyes). Intraoperative bleeding was classified as Grades 1 to 3 from mild to severe degree. The follow-up period was at least 3 months.
Results: Minimal bleeding (Grade 1) during vitrectomy and attached retina were discovered after surgery in all patients of Groups 1, 2 and 3. At the end of follow-up, the best-corrected visual acuity improved from 1.77±0.71 to 0.89±0.51 logMAR (p＜0.001). Increased visual acuity was found in all groups after surgery (p＜0.05). Early postoperative hemorrhage occurring within 3 months was found in 7% of eyes in Group 3, significantly lower than 25% and 28.6% of eyes in Groups 1 and 2 (p＜0.01).
Conclusion: Bevacizumab as a pre-vitrectomy adjunct in cases with severe PDR causes minor intraoperative bleeding in all groups. However, early postoperative hemorrhage occurs after surgery in some of the patients, and cases with silicone oil tamponade have lower rate of early bleeding than those treated with vitrectomy alone or with long-acting gas infusion.

並列摘要

Background and Objective: To investigate the short-term clinical outcome of intravitreal bevacizumab (IVB) pretreatment in patients with severe proliferative diabetic retinopathy (PDR) requiring vitrectomy.
Materials and Methods: We enrolled 28 eyes of 24 patients with PDR pretreated by IVB (1.25 mg/0.05 ml) for an average of 9.2 days before vitrectomy. The patients were divided into three groups: Group 1-vitrectomy alone (8 eyes), Group 2-vitrectomy with C3F8 tamponade (7 eyes), and Group 3-vitrectomy and silicone oil infusion (13 eyes). Intraoperative bleeding was classified as Grades 1 to 3 from mild to severe degree. The follow-up period was at least 3 months.
Results: Minimal bleeding (Grade 1) during vitrectomy and attached retina were discovered after surgery in all patients of Groups 1, 2 and 3. At the end of follow-up, the best-corrected visual acuity improved from 1.77±0.71 to 0.89±0.51 logMAR (p＜0.001). Increased visual acuity was found in all groups after surgery (p＜0.05). Early postoperative hemorrhage occurring within 3 months was found in 7% of eyes in Group 3, significantly lower than 25% and 28.6% of eyes in Groups 1 and 2 (p＜0.01).
Conclusion: Bevacizumab as a pre-vitrectomy adjunct in cases with severe PDR causes minor intraoperative bleeding in all groups. However, early postoperative hemorrhage occurs after surgery in some of the patients, and cases with silicone oil tamponade have lower rate of early bleeding than those treated with vitrectomy alone or with long-acting gas infusion.

並列關鍵字

Intravitreal injection ； bevacizumab ； proliferative diabetic retinopathy ； vitrectomy