The adjunctive use of pre-operative intravitreal bevacizumab in the setting of proliferative diabetic retinopathy

Purpose: To evaluate the efficacy of pre-operative intravitreal bevacizumab injection on the rate of postoperative vitreous hemorrhage in patients undergoing vitrectomy for complications of proliferative diabetic retinopathy. Methods: Consecutive retrospective comparative cohort study. Forty eyes of 37 patients who received pre-operative intravitreal bevacizumab 1.25 mg were compared to a similar group of 44 eyes of 44 patients who had undergone vitrectomy surgery prior to the availability and widespread use of pre-operative intravitreal bevacizumab. The primary outcome measure was the incidence of post-vitrectomy hemorrhage at one week after surgery. Secondary outcome measures included are postoperative vitreous hemorrhage at one month and changes in the best-corrected visual acuity (BCVA). For statistical analysis, the paired Student's t-test and Fisher's exact test were used. Results: Four out of 40 eyes (10%) pretreated with intravitreal bevacizumab vs. 12 of 44 eyes (27%) not pretreated with intravitreal bevacizumab had a clinically significant postoperative vitreous hemorrhage at one week. The mean best-corrected visual acuity (BCVA) in bevacizumab group improved from a mean of hand motions to a mean of 20/300 at 1 month (range: 20/25-light perception; p <.001) and mean BCVA in the non-injected group improved from preoperative mean of hand motion to 20/200 at one month follow-up (range: 20/25-no light perception; p <.001). In both groups, 4 patients (12%) needed repeat vitrectomy. Conclusion: There is a trend to reduced incidence of early post-vitrectomy hemorrhage in patients undergoing vitrectomy for complications of proliferative diabetic retinopathy that have been pre-treated with intravitreal bevacizumab 1 week prior to surgery.