Microincision Vitrectomy Surgery and Intravitreal Bevacizumab as a Surgical Adjunct to Treat Diabetic Traction Retinal Detachment
Received 6 June 2008; received in revised form 4 November 2008; accepted 4 November 2008. published online 09 March 2009.
Purpose
To investigate the feasibility and efficacy of microincision vitrectomy surgery (MIVS) combined with intravitreal bevacizumab (IVB) as a surgical adjunct for treating traction retinal detachment (TRD) secondary to severe proliferative diabetic retinopathy (PDR).
Design
Retrospective, comparative, consecutive, interventional case series.
Participants
Seventy-one eyes of 59 consecutive patients who underwent primary vitrectomy for diabetic TRD and were followed up for more than 6 months after surgery.
Methods
Eyes that received IVB (1 mg) as a preoperative adjunct followed by MIVS (IVB/MIVS group) from November 2005 through December 2007 were compared with eyes that underwent conventional 20-gauge pars plana vitrectomy (20-g PPV group) from September 2003 through October 2005.
Main Outcome Measures
Primary and ultimate anatomic success, intraoperative and postoperative complications, and final visual success with at least 6 months of follow-up.
Results
This series included 38 eyes (33 patients) in the IVB/MIVS group and 33 eyes (26 patients) in the 20-g PPV group. The primary and ultimate anatomic success rates (95% vs. 91% and 100% in both groups, respectively) and the mean visual acuity changes did not differ significantly between groups; the surgical time and intraoperative bleeding in the IVB/MIVS group decreased significantly compared with the 20-g PPV group (P<0.001). The rate of visual improvement of 3 lines or more at the 6-month follow-up was 68% in the IVB/MIVS group and 49% in the 20-g PPV group, respectively. Progression of the preexisting TRD after IVB occurred in 7 eyes (18%). Absence of previous laser photocoagulation (P = 0.025) and the presence of a ring-shaped fibrovascular membrane (P = 0.013) were relevant findings in eyes with these IVB-induced complications.
Conclusions
Intravitreal bevacizumab plus MIVS offers comparable anatomic success compared with conventional 20-gauge PPV in patients with TRD resulting from severe PDR. This technique shortens the surgical time with fewer intraoperative complications and favorable visual recovery. However, caution should be taken because of rapid progression of the preexisting TRD after IVB in some patients.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Available online: March 9, 2009.
1Department of Ophthalmology, Osaka University Medical School, Osaka, Japan
2Department of Ophthalmology, Kagawa University Faculty of Medicine, Kagawa, Japan
3Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
Correspondence: Yusuke Oshima, MD, Department of Ophthalmology, Osaka University Medical School, Room E7, 2-2 Yamadaoka, Suita 565-0871, Japan
Manuscript no. 2008-695.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported in part by research grants from the Ministry of Education, Science and Culture, Tokyo, Japan.
ABSTRACT