Study results provide new information about the risk and strategies for preventing tractional retinal detachment (TRD) development or progression in eyes with severe proliferative diabetic retinopathy (PDR) receiving intravitreal bevacizumab (Avastin, Genentech) prior to vitrectomy.
Conducted as a larger follow-on to a previously published, retrospective study that included 211 intravitreal bevacizumab injections [Arevalo JF, et al. Br J Ophthalmol. 2008;92(2):213-216], the current retrospective, multicenter study reviewed 698 cases and found TRD developed or progressed in 25 eyes (25 patients, 3.2%).
Advanced proliferative diabetic retinopathy. A) Color photograph. B) Fluorescein angiogram demonstrating neovascularization (NVD and NVE). C-D) Three weeks after intravitreal bevacizumab (1.25 mg), the patient developed tractional retinal detachment temporal to the foveal with areas of lack of perfusion (D). Note that the areas of hyperfluorescence corresponding to NVE and NVE had regressed (D). (Images courtesy of J. Fernando Arevalo, MD)
All 25 patients had PDR refractory to panretinal photocoagulation (PRP) and uncontrolled diabetes mellitus associated with an elevated HBA1c. Although the average time to onset or progression of TRD was 13 days (range 3 to 31), it occurred within 5 days after the bevacizumab injection in 82% of the 25 eyes.
Twenty-five percent of eyes had a ≥2-line loss from their baseline best corrected visual acuity (BCVA) after vitrectomy, reported J. Fernando Arevalo, MD, the Edmund F. and Virginia B. Ball Professor of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore. He is also chairman, Department of Ophthalmology, Johns Hopkins Bayview Medical Center.
“Adjuvant use of bevacizumab in eyes undergoing vitrectomy for PDR has many advantages,” Dr. Arevalo explained. “By reducing the risk of intraoperative bleeding, it may facilitate the removal of fibrovascular membranes and provide better visibility that reduces the likelihood of creating an iatrogenic retinal break. In addition, chances of postoperative complications, such as rebleeding or fibrinoid syndrome, may be reduced.”