Preoperative Bevacizumab Benefits Patients With Diabetes With Vitreous Hemorrhage Without Tractional Detachment

Injecting preoperative bevacizumab into treatment-naïve eyes of patients with proliferative diabetic retinopathy and vitreous hemorrhage without tractional retinal detachment led to better macular status and slightly improved vision 1 month after surgery, according to a study published in the Indian Journal of Ophthalmology.

“Surprisingly, there have been very few studies on this unique scenario in the past to understand how preoperative anti-vascular endothelial growth factor [agents] may influence the macular structure and function in the immediate postoperative period,” researchers wrote.

The quasi-randomized retrospective multicenter study, which involved four tertiary eye care centers in India, included 217 treatment-naïve eyes of 217 patients with proliferative diabetic retinopathy and nonclearing vitreous hemorrhage without tractional retinal detachment. Patients underwent vitrectomy, with 49% receiving bevacizumab 3 to 5 days before surgery and 51% not receiving the agent. Preoperative characteristics were comparable between the groups.

One month after surgery, average central macular thickness was significantly higher in patients who did not receive preoperative bevacizumab, according to the study. Furthermore, the likelihood of developing center-involving diabetic macular edema was two-thirds lower with preoperative bevacizumab.

Although both patient groups showed significantly improved visual acuity, it was marginally better in patients who received preoperative bevacizumab. Researchers also noted a trend toward fewer intravitreal injections in the 6 months after surgery in patients that received preoperative bevacizumab, but the difference was not statistically significant.

The enhanced macular status and marginally improved vision demonstrated in the preoperative bevacizumab group 1 month after surgery was maintained at a 6-month follow-up, the study found.

“In view of these results, patients may be offered bevacizumab in this scenario and the drug administered only when it is readily affordable to patients,” researchers wrote.

Reference:
Chakraborty D, Maiti A, Kelkar A, et al. Outcomes of preoperative bevacizumab in diabetics with nonclearing vitreous hemorrhage without tractional detachment - a quasi-randomized retrospective study. Indian J Ophthalmol. 2021;69(11):3283-3287. doi:10.4103/ijo.IJO_1264_21