Title

INTRAVITREAL BEVACIZUMAB (IVB) VERSUS IVB IN COMBINATION WITH PARS PLANA VITRECTOMY (PPV) FOR VITREOUS HEMORRHAGE SECONDARY TO PROLIFERATIVE DIABETIC RETINOPATHY (PDR): A RANDOMIZED CLINICAL TRIAL

Introduction

To compare the vitreous hemorrhage(VH) score reduction in patients with PDR submitted only to intravitreal injections of bevacizumab (IVB)with patients submitted to PPV and IVB.

Methods

Patients with VH secondary to PDR were randomized into 2 groups:GroupA:patients received a total of 3 IVB 0.06ml (1.50mg) at 8 week intervals;and GroupB:patients were submitted to PPV plus IVB 7 days before PPV.Patients underwent an ophthalmic evaluation that included best-corrected visual acuity (BCVA),retinal mapping and mode B echography at 8, 16 and 24 weeks after intervention.VH was classified according to the DRVS in grades 1,2or 3.Change in VH score was the primary outcome measure and change in BCVA was the secondary outcome.

Results

Sixty-four patients(70 eyes) completed the 24-week follow-up visit.Mean VH score reduction(± SEM) of 0.45 ± 0.14(p = 0.0014),1.34 ± 0.14(p <0.0001) and 1.82 ± 0.14(p <0.001) was observed in groupA at 8,16 and 24 weeks after treatment, respectively.In GroupB,the reduction of VH score(± SEM) was 2.25 ± 0.14(p = 0.0014),2.28 ± 0.14(p <0.0001) and 2.22 ± 0.14(p <0.001)respectively.Group comparison revealed a significantly greater reduction in mean vitreous score in groupB in 8 and 16 weeks after treatment (p<0.0001).However, at week 24, this difference was no longer statistically significant(p=0.1854).Group A,mean LogMAR BCVA(± SEM) showed an improvement of 0.002 ± 0.09(p = 0.971),0.53 ± 0.09(p <0.0001),0.81 ± 0.09(p <0.0001) and 0.85 ± 0.09(p <0.0001)compared to baseline at 1,8,16 and24 weeks after treatment,respectively. In group B,mean BCVA(± SEM)showed an improvement of 0.36 ± 0.09(p=0.0002),0.88 ± 0.095(p<0.0001),0.94 ± 0.09(p<0.0001)and 0.96 ± 0.09(p<0.0001)compared to the same period.No significant difference in BCVA was observed between groups at week 24.

Discussion

PPV and preoperative IVB leads to a faster clearance of VH than IVB injections alone.However,after 24 weeks of follow-up,the reduction on VH score was similar between both treatment strategies.

Keywords

vitreous hemorrhage, diabetic retinophaty, vitrectomy, intravitreous injection

Area

SURGICAL CASE

Authors

Danilo Moyses Jorge, José Edísio Tavares Neto, Rodrigo Jorge, Ingrid U Scott, Omero Poli Neto