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Br J Ophthalmol doi:10.1136/bjo.2007.127142

Tractional Retinal Detachment following Intravitreal Bevacizumab (Avastin®) in patients with Severe Proliferative Diabetic Retinopathy

  1. J. Fernando Arevalo (arevalojf{at}movistar.net.ve),
  2. Mauricio Maia,
  3. Harry Flynn, Jr (hflynn{at}med.miami.edu),
  4. Mario Saravia,
  5. Robert L. Avery (avery991{at}cox.net),
  6. Lihteh Wu,
  7. Michel E Farah,
  8. Dante J. Pieramici,
  9. Maria H. Berrocal,
  10. Juan G. Sanchez
  1. Clinica Oftalmologica Centro Caracas, Venezuela
  2. Universidade Federal de São Paulo - Departamento de Oftalmologia - Instituto da Visão, Brazil
  3. Bascom Palmer Eye Institute, United States
  4. the Hospital Universitario Austral, Argentina
  5. California Retina Consultants and Research Foundation, United States
  6. Instituto de Cirugia Ocular, Costa Rica
  7. Universidade Federal de São Paulo - Departamento de Oftalmologia - Instituto da Visão, Brazil
  8. California Retina Consultants and Research Foundation, United States
  9. University of Puerto Rico, Puerto Rico
  10. Retina and Vitreous Service, Clinica Oftalmológica Centro Caracas, Venezuela
    • Published Online First 26 October 2007

    Abstract

    Aims: To report the development or progression of tractional retinal detachment (TRD) after the injection of intravitreal bevacizumab (Avastin®) used as an adjuvant to vitrectomy for the management of severe proliferative diabetic retinopathy (PDR).

    Methods: The clinical charts of patients who experienced the development or progression of TRD after an intravitreal injection of 1.25 mg of bevacizumab before vitrectomy for the management of PDR were reviewed.

    Results: Eleven eyes (patients) out of 211 intravitreal injections (5.2%) that developed or had progression of TRD were identified. All eyes had PDR refractory to panretinal photocoagulation (PRP). Nine patients had diabetes mellitus (DM) type 1, and two patients had DM type 2. Patients had a mean age of 39.5 years old (range from 22 to 62 years old). In the current study, all patients used insulin administration, and poor glycemic control (HbA1c mean = 10.6%). Time from injection to TRD had a mean of 13 days (range: 3 to 31 days). Mean best-correct visual acuity (BCVA) at TRD developed or progression was LogMAR = 2.2 (range: 1.0 to 2.6) (mean Snellen equivalent: HM; range: 20/200 to LP), a statistically significant worsening compared to baseline BCVA (p < 0.0001). Eight eyes underwent vitrectomy and three patients refused or were unable to undergo surgery. The final mean BCVA after surgery was LogMAR = 0.9 (range: 0.2 to 2.0) (mean Snellen equivalent: 20/160; range: 20/32 to CF), a statistically significant improvement compared to TRD BCVA (p = 0.002).

    Conclusions: Tractional retinal detachment may occur or progress shortly following administration of intravitreal bevacizumab in patients with severe PDR.

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