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Perioperative bevacizumab injection: clinical and histological results
Author(s) -
ROMANO MR,
GIBRAN SK,
WONG D,
HISCOTT P,
HEIMANN H
Publication year - 2008
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2008.4416.x-i1
Subject(s) - medicine , bevacizumab , vitrectomy , diabetic retinopathy , surgery , perioperative , prospective cohort study , ophthalmology , group b , visual acuity , diabetes mellitus , chemotherapy , endocrinology
Purpose To evaluate the safety and efficacy of Intravitreal Bevacizumab (IVB) injection as an adjuvant in the management of proliferative diabetic retinopathy (PDR) before or after planned vitrectomy. Methods Prospective, interventional, consecutive case series of 58 eyes of 55 patients with PDR. The patients were divided in two groups: Group A (28 eyes) had IVB within 10 days before the surgery; Group B (30 eyes) had the IVB at the end of the surgery. A dose of IVB was of 2.5mg in 0.1 ml and was given under aseptic conditions. The specimens obtained from the both groups were evaluated by histological examination. Results In Group A, 3 of 28 eyes (12%) had no significant reduction of neovascularisation; 8 of 28 eyes (28%) had a significant reduction in leakage and regression of tractional retinal detachment (TRD) with parallel improvement in visual acuity. Four (50%) of these 8 patients had recurrence of PDR within 10 weeks after the injection. In 2 patients, worsening of TRD was noted. In 11 patients, vitrectomy, delamination and endolaser laser were performed within 10 days. Post‐operative bleeding was not noted in this group. In Group B, 7 out of 30 eyes (23%) had a re‐bleeding within one month from the surgery. No difference in morphology was observed between the specimens of the two groups. An analogous staining pattern was observed between two groups when comparing markers for apoptosis (caspase), hypoxia (HIF1 and HIF2) and VEGF. Conclusion IVB seems to be efficacious as an adjuvant treatment, if injected pre‐operatively rather than post‐operatively, for the management of PDR. IVB does not appear to cause any change in the light microscopic appearance or in the immunohistochemically‐detectable expression of hypoxia or apoptosis markers.