Título

THE USE OF ANTI-VEGF IN NON-CLEARING VITREOUS HEMORRHAGE (VH) CAUSED BY PROLIFERATIVE DIABETIC RETINOPATHY (PDR): A PROSPECTIVE, COMPARATIVE STUDY

Introdução / Purpose

Compare the rate of vitreous clearing with the use of intravitreous anti-VEFG
in eyes with VH due to PDR subjected to monthly injections of bevacizumab or sham
injections.

Material e Método / Methods

Prospective, longitudinal, comparative, interventionist study. Patients were randomized to receive monthly either 1.25 mg of intravitreous bevacizumab (BVZ) or sham injection (Sham) up to 6 treatments. Main inclusion criteria: age ≥ of 18 years-old, diabetic patients with visual acuity < 20/40 caused by vitreous hemorrhage with ≥30 days of evolution. Main exclusion criteria: tractional retinal detachment, prior treatment with anti-VEGF ≤30 days before inclusion, and prior vitrectomy (PPV).  
VH was classified accordingly to its severity in a 1 to 5 scale (VH severity scale).  
Primary outcome:  number of eyes with reduction of ≥2 steps in the VH severity scale. Secondary outcomes: need for PPV, number of injections, ability to complete panretinal photocoagulation (PRP), and VA analysis between baseline and at 6 months. This study was approved by the Ethics Committee of the Institution under the number CAAE: 673447 17.4.0000.0088 

Resultados / Results

The bevacizumab group consisted of 8 patients with a mean age of 61.2 ± 11.3 years (6 males) and the sham group comprised 5 patients with a mean age of 60.6 ± 11.4 years (3 males). 
Primary outcome was achieved at some point of the follow-up in 75% In the BVZ (mostly in the first three months), and in 40% in the sham (at the first or sixth month).  One patient in sham was submitted to PPV and none in the BVZ. 

Discussão e Conclusões / Discussion

VH can be recurrent in patients with PDR and may prevent complete PRP treatment to be achieved. We hypothesized that with the use of continuous anti-VEGF drug may suppress the source of rebleeding, allowing vitreous clearing, thus permitting completion of PRP, and ultimately avoiding PPV. In our study, the BVZ group achieved the primary outcome in a greater percentage of patients comparing to the sham group. Further studies are warranty to prove these results. 

Palavras Chave

Intravitreal bevacizumab; vitreous hemorrhage; proliferative diabetic retinopathy