Preoperative Bevacizumab for Tractional Retinal Detachment in Proliferative Diabetic Retinopathy: A Prospective Randomized Clinical Trial

被引：30

作者：

Arevalo, J. Fernando ^{[1
,2
,16
]}

Lasave, Andres F. ^{[3
,10
,11
]}

Kozak, Igor ^{[4
]}

Al Rashaed, Saba ^{[4
]}

Al Kahtani, Eman ^{[4
]}

Maia, Mauricio ^{[5
,18
]}

Farah, Michel E. ^{[5
]}

Cutolo, Caroline ^{[5
]}

Brito, Miguel ^{[6
]}

Osorio, Claudia ^{[6
]}

Navarro, Patricia ^{[6
]}

Wu, Lihteh ^{[7
,17
]}

Berrocal, Maria H. ^{[8
]}

Morales-Canton, Virgilio ^{[9
]}

Serrano, Martin A. ^{[10
,11
]}

Graue-Wiechers, Federico ^{[12
]}

Sabrosa, Nelson Alexandre ^{[13
]}

Alezzandrini, Arturo A. ^{[14
]}

Gallego-Pinazo, Roberto ^{[15
]}

Liu, T. Y. A. ^{[16
]}

Farah, M. ^{[18
]}

Penha, F. M. ^{[18
]}

Rodrigues, E. B. ^{[18
]}

Fromow-Guerra, J. ^{[9
]}

-Naranjo, J. L. Guerrero ^{[9
]}

Dalma-Weiszhausz, J. ^{[9
]}

Velez-Montoya, R. ^{[9
]}

Quiroz-Mercado, H. ^{[9
]}

Rodriguez, F. J. ^{[19
]}

Gomez, F. E. ^{[19
]}

Brieke, A. C. ^{[19
]}

Goveto, A. ^{[19
]}

Berrocal, M. H. ^{[20
]}

Cruz-Villegas, V. ^{[20
]}

Lozano-Rechy, D. ^{[12
]}

Fulda-Graue, E. ^{[12
]}

Roca, J. A. ^{[21
]}

Hernandez, A. ^{[21
]}

Saravia, M. J. ^{[22
]}

Schlaen, A. ^{[22
]}

Rojas, J. ^{[22
]}

Lngolotti, M. ^{[22
]}

Avila, M. ^{[23
]}

Carla, L. ^{[23
]}

Cardillo, J. ^{[24
,25
]}

Jorge, R. ^{[24
,25
]}

Carpentier, C. ^{[26
]}

Verdaguer T, J. ^{[26
]}

Verdaguer D, J. I. ^{[26
]}

Sepulveda, G. ^{[26
]}

机构：

[1] Johns Hopkins Univ, Sch Med, Wilmer Eye Inst, Retina Div, Baltimore, MD 21205 USA

[2] Univ Stellenbosch, Fac Hlth Sci, Div Ophthalmol, Tygerberg, South Africa

[3] Clin Privada Ojos, Retina & Vitreous Dept, Buenos Aires, DF, Argentina

[4] King Khalid Eye Specialist Hosp, Vitreoretinal & Uveitis Div, Riyadh, Saudi Arabia

[5] Fed Univ Sao Paulo UNIFESP, Dept Ophthalmol & Visual Sci, Retina Div, Sao Paulo, SP, Brazil

[6] IDEO, Maracaibo, Venezuela

[7] Inst Cirugia Ocular, San Jose, Costa Rica

[8] Univ Puerto Rico, Dept Ophthalmol, San Juan, PR 00936 USA

[9] Asociac Evitar Ceguera Mexico, Mexico City, DF, Mexico

[10] Clin Oftalmol Ctr Caracas, Caracas, Venezuela

[11] Arevalo Coutinho Fdn Res Ophthalmol, Caracas, Venezuela

[12] Fdn Conde Valenciana, Mexico City, DF, Mexico

[13] Clin Olhos Gavea, Rio De Janeiro, Brazil

[14] OFTALMOS Univ Buenos Aires, Fac Med, Buenos Aires, DF, Argentina

[15] Gen Univ Valencia, Consorcio Hosp, Valencia, Spain

[16] Johns Hopkins Univ, Wilmer Eye Inst, Baltimore, MD 21218 USA

[17] Asociados Macula Vitreo & Retina Costa Rica, San Jose, Costa Rica

[18] Univ Fed Sao Paulo, Dept Oftalmol, Inst Visao, Sao Paulo, SP, Brazil

[19] Univ Rosario, Fdn Oftalmol Nacl, Bogota, Colombia

[20] Univ Puerto Rico, San Juan, PR 00936 USA

[21] Clin Ricardo Palma, Lima, Peru

[22] Hosp Univ Austral, Buenos Aires, DF, Argentina

[23] Univ Fed Goias, Dept Oftalmol, Goiania, Go, Brazil

[24] Hosp Olhos Araraquara, Sao Paulo, SP, Brazil

[25] Univ Sao Paulo, Sao Paulo, SP, Brazil

[26] Fdn Oftalmol Los Andes, Santiago, Chile

[27] Univ Buenos Aires, Catedra Oftalmol, OFTALMOS, Buenos Aires, DF, Argentina

[28] Univ Valencia, Hosp La Fe, Valencia, Spain

[29] Hosp Univ Ramon y Cajal, Dept Retina, Madrid, Spain

[30] VISSUM Madrid, Madrid, Spain

来源：

AMERICAN JOURNAL OF OPHTHALMOLOGY | 2019年 / 207卷

关键词：

INTRAVITREAL BEVACIZUMAB; IRIS NEOVASCULARIZATION; VISUAL-LOSS; VITRECTOMY; INJECTION; AVASTIN; ADJUNCT; MANAGEMENT; REGRESSION; SURGERY;

D O I：

10.1016/j.ajo.2019.05.007

中图分类号：

R77 [眼科学];

学科分类号：

100212 ;

摘要：

PURPOSE: To assess the effectiveness and safety of an intravitreal injection of 1.25 mg bevacizumab (IVB) as a preoperative adjunct to small-gauge pars plana vitrectomy (PPV) compared with PPV alone in eyes with tractional retinal detachment secondary to proliferative diabetic retinopathy. METHODS: This prospective, double-masked, randomized, multicenter, active-controlled clinical trial enrolled 224 eyes of 224 patients between November 2013 and July 2015. All eyes underwent a baseline examination including best-corrected visual acuity, color photos, optical coherence tomography, and fluorescein angiography. Data were collected on intraoperative bleeding, total surgical time, early (< 1 month) postoperative vitreous hemorrhage, and mean change in best-corrected visual acuity at 12 months. P < .05 was considered statistically significant. RESULTS: A total of 214 patients (214 eyes) were randomized in a 1:1 ratio to PPV plus IVB ([study group] 102 eyes) or PPV plus sham ([control] 112 eyes). Iatrogenic retinal breaks were noted intraoperatively in 35 eyes (34.3%) in the study group, and 66 eyes (58.9%) in the control group (P = .001). Grade 2 intraoperative bleeding was noted in 32 (31.3%) eyes in the study group and 58 (51.7 %) eyes in the control group (P = .001). Endodiathermy was necessary in 28 (27.4 %) eyes in the study group, compared with 75 (66.9%) eyes in the control group (P = .0001). Mean surgical time was 71.3 +/- 32.1 minutes in the study group and 83.6 +/- 38.7 minutes in the control group (P = .061). CONCLUSION: Preoperative IVB seems to reduce intraoperative bleeding, improving surgical field visualization, and reducing intraoperative and postoperative complications. (C) 2019 Elsevier Inc. All rights reserved.

引用

页码：279 / 287

页数：9

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