Safety and Efficacy of Preop Intravitreal Triamcinolone Plus Bevacizumab Combination and Bevacizumab Alone in Vitreous Surgery for Non-Resolving Vitreous Haemorrhage in Proliferative Diabetic Retinopathy (PDR) (original) (raw)
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2017
Objective: To evaluate the effect and safety of bevacizumab pretreatment on visual acuity after pars plan vitrectomy for diabetic vitreous Haemorrhage. Study design: Prospective, cohort study. Setting: Ophthalmology unit III, Mayo Hospital, King Edward Medical University Lahore Pakistan. Duration: The study was carried out in one year, from 01, January 2013 to 31, December 2013. Materials and methods: A total of sixty patients diagnosed with dense non clearing diabetic vitreous haemorrhage fulfilling inclusion and exclusion criteria were identified and registered. In group A, thirty (30) eyes were treated preoperatively with Bevacizumab and in group B thirty (30) eyes were not treated with Bevacizumab before vitrectomy for diabetic vitreous haemorrhage. All patients were followed for post operative outcome measures including best corrected visual acuity (BCVA), post operative vitreous haemorrhage, and other complications for three to six months. Results: At six (06) months foll...
Journal of Clinical & Experimental Ophthalmology, 2015
Purpose: To evaluate the visual, anatomical outcomes, complications and the predictive preoperative and intraoperative factors of pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) in a large Asian tertiary eye center Methods: This is a consecutive retrospective review of 106 eyes that underwent PPV for PDR complications in 2013. The functional success was defined as visual acuity of 20/200 or better while the anatomical success was defined as 360° flat retina without endo-tamponade at one year. Results: The overall functional and anatomical success was 77.4% and 94.3%, respectively. The common complications were iatrogenic break (14.2%), raised intraocular pressure (IOP) (13.2%), cataract (13.2%) and recurrent vitreous hemorrhage (12.3%). The use of intraoperative triamcinolone (OR: 0.36, p=0.04) and silicone oil (OR: 0.08, p<0.001) were associated with poorer visual success. The iatrogenic breaks occurred more often in 20G PPV than 23G PPV (OR: 5.89, p=0.02) whereas intraoperative silicone oil were associated with postoperative raised IOP (OR: 3.71, p=0.04). The use of bevacizumab was not found to reduce recurrent vitreous hemorrhage (OR: 0.53, 95%CI: 0.11-2.53, p=0.43). Conclusions: In the era of small gauge vitrectomy, the visual, anatomical outcomes and complication rates of PPV for PDR patients in Singapore had improved significantly, as compared to the Diabetic Retinopathy Vitrectomy Study.
Eye, 2012
The study reports 10-year anatomical and visual outcome in patients who underwent pars plana vitrectomy (PPV) for complications due to proliferative diabetic retinopathy (PDR). Methods Retrospective analysis of patients undergoing 20G PPV from January 1999 to May 2010 for tractional retinal detachment (TRD) and non-clearing vitreous hemorrhage (NCVH) secondary to PDR recorded prospectively on an electronic patient record. The primary aim was to study anatomical success and eyes with visual acuity (VA) of r0.3 logMAR at last follow-up. Results There were 346 eyes of 249 patients with mean age of 55.63 years and follow-up of 1.44 years. In all, 95.3% of eyes had a flat retina at final follow-up. Overall 136/346 (39.4%) eyes had final VA of logMAR r0.3 (Snellen 6/12) and 129 (37.3%) had logMAR Z1.0 (Snellen 6/60). In all, 50/181 (27.6%) eyes with TRD and 84/165 (50.9%) with NCVH achieved final VA of r0.3 logMAR (Snellen 6/12). A total of 218 (63.1%) showed Z0.3 logMAR improvement from baseline to last follow-up. Both preoperative VA and final postoperative (post-op) VA (Po0.001) improved significantly with each year from 1999 to 2010. The commonest peroperative complication was iatrogenic retinal tear formation (28.4%). This was a risk factor for the development of post-op retinal detachment, odds ratio: 3.90 (95% confidence interval: 1.91-7.97, P ¼ 0.0002). Silicone oil was used in 5.2% of patients at the primary procedure. In all, 9.2% required removal of non clearing post vitrectomy hemorrhage. Conclusions Outcomes from vitreoretinal surgery for complications of diabetic retinopathy have improved. In addition, the visual outcome after diabetic vitrectomy steadily improved over the 10-year period, which may in part be due to the move to operate on patients with better vision.
Journal of the College of Physicians and Surgeons Pakistan, 2019
Objective: To evaluate the visual outcomes of pars plana vitrectomy (PPV) alone or with intravitreal bevacizumab in patients of diabetic vitreous haemorrhage. Study Design: A quasi-experimental study. Place and Duration of Study: Al-Ibrahim Eye Hospital, Malir, Karachi, from March to November 2018. Methodology: Patients between 40-70 years of age, irrespective of gender with non-resolving dense diabetic vitreous haemorrhage were divided into two groups. Group A received injection bevacizumab 7 days before PPV surgery. Group B received no preoperative injection. Log Mar chart was used for documenting postoperative vision. All patients completed their 6 months follow-up. SPSS was used to analyse the data. Results: Best corrected visual acuity (BCVA) was documented as improved, same, or worse. In Group A, 21 (70%) patients had improved VA; whereas, in Group B, 17 (56.6%) patients showed improved visual acuity postoperatively. Patients were examined at four weeks, three months, and six months, respectively for recurrent vitreous haemorrhage. In Group A, 25 (83.3%) patients had no vitreous haemorrhage up to six months, whereas, in Group B, 13 (43.3%) patients had no vitreous haemorrhage up to six months with p-value of 0.021. Conclusion: Anti VEGF injection bevacizumab before PPV in patients with non-resolving diabetic vitreous haemorrhage is good to get better results in terms of BCVA, as well as reduce the incidence of recurrent vitreous haemorrhage.
Ophthalmology and Eye Diseases, 2013
We evaluated the effect of intravitreal bevacizumab (IVB) injection before pars plana vitrectomy (PPV) on intravitreal hemorrhage (VH) during and after vitrectomy for postoperative the first day and the first month in pseudophakic patients with proliferative diabetic retinopathy (PDR). This retrospective study was performed on 44 eyes of 44 patients who underwent vitrectomy for PDR. Patients were divided into PPV (n = 22 eyes) and PPV + IVB (n = 22 eyes) groups. Injection of bevacizumab (1.25 mg/0.05 mL) was performed 3 days before vitrectomy. Outcomes of visual acuity as well as intraoperative and postoperative VH were compared between the two groups. One month after surgery, visual acuity improved in PPV and PPV + IVB groups (P = 0.005, P = 0.006), respectively. There was no difference between the two groups in best corrected visual acuity at baseline and after vitrectomy (P = 0.71). Intraoperative bleeding into the vitreous was recorded in 14 (63.6%) cases in the PPV group and in 7 (31.8%) cases in the PPV + IVB group. The first month, intravitreal hemorrhage was recorded in six patients in the PPV group and in two patients in the PPV + IVB group (P = 0.03). The mean pre-postoperative central macular thickness was similar in both groups. Intravitreal injection of IVB before vitrectomy decreased the rate of VH at the time of surgery and at the first postoperative month in patients with PDR.
European Journal of Ophthalmology, 2014
Purpose To assess the effect of intravitreal bevacizumab (IVB) on the incidence of postoperative recurrent vitreous hemorrhage (VH) in eyes operated for diabetic VH when injected at the end of the surgery. Methods A prospective, comparative clinical trial was conducted on a consecutive series of patients requiring vitrectomy for diabetic nonclearing VH. Intravitreal bevacizumab (2.5 mg/0.1 mL) was injected at the completion of surgery. Patients underwent best-corrected visual acuity (VA), applanation tonometry, and biomicroscopic anterior and posterior segment evaluation for VH grading. Postoperative visits were performed at the first day, first week, first month, third month, and sixth month. The VH was graded at each visit, and the rate of postoperative VH and VA improvement and potential complications were evaluated and compared between the groups. Results A total of 72 eyes of 66 patients were included. Thirty-four eyes were enrolled in the IVB group and 38 eyes were enrolled in...
2014
Material and Methods: Randomized clinical trial conducted at LRBT, Free Base Eye Hospital, Karachi, from January 2010 to June 2012. Two hundred sixty patients of vitreous haemorrhage secondary to proliferative diabetic retinopathy (Type – l diabetes mellitus) were randomly selected, age range between 30 – 70 years, 23 – gauge (n = 130) group A; males 73 (56.16%), females 57 (43.85%) and 20 – gauge pars plana vitrectomy (n = 130) group B; males 70 (53.85%), females 60 (46.15%). Post-operative follow up were at day one, 1 week, 1 month, 2 month, 3 month and final 6 month. Data was analyzed and compared for post-operative best corrected visual acuity (BCVA) and complications between two groups.