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Intraoperative Bleeding during Vitrectomy for Diabetic Tractional Retinal Detachment With versus Without Preoperative Intravitreal Bevacizumab (IBeTra Study)
  1. Daniel R Lucena (drlucena{at}terra.com.br),
  2. Jefferson A S Ribeiro (jef_ribeiro{at}yahoo.com.br),
  3. Rogério A Costa (rog.retina{at}uol.com.br),
  4. José C Barbosa (jcbarbosa{at}fcav.unesp.br),
  5. Ingrid U Scott (iscott{at}psu.edu),
  6. Lorena L Figueiredo-Pontes (lorenafigdo{at}yahoo.com.br),
  7. Rodrigo Jorge (rjorge{at}fmrp.usp.br)
  1. School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
  2. School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
  3. MacIma – Macular Imaging & Treatment Division, Hospital de Olhos de Araraquara, Brazil
  4. Department of Exact Sciences, São Paulo State University, Jaboticabal, Brazil
  5. Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, United States
  6. Laboratory of Hematology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
  7. School of Medicine of Ribeirão Preto, University of São Paulo, Brazil

    Abstract

    Aims: To compare the amount of intraoperative intraocular bleeding in diabetic patients with macula-involving tractional retinal detachment (TRD) undergoing pars plana vitrectomy (PPV) with and without preoperative intravitreal bevacizumab (IVB) injection.

    Methods: An institutional study was carried out with consecutive patients with diabetic retinopathy and macula-involving TRD of recent (3 months) onset who were randomly assigned to PPV only (PPV group) or PPV combined with one IVB (1.5mg/0.06mL) injection 2 weeks prior to surgery (BEV/PPV group). All patients underwent 23-gauge PPV 3 weeks after baseline. The main outcome measure was erythrocyte count in the fluid retrieved from the vitrectomy cassette using a Neubauer counting chamber.

    Results: The study included 20 patients. The mean (standard deviation) erythrocyte count was 14865 x 1000 (±19332 x 1000; median, 4500 x 1000) cells in the BEV/PPV group, and 176240 x 1000 (±108375 x 1000; median, 166600 x 1000) cells in the PPV group. The mean erythrocyte count was significantly lower in the BEV/PPV group compared with PPV group (P < 0.0001). No major adverse events were identified.

    Conclusion: Preoperative IVB injection was associated with reduced intraocular bleeding during 23-gauge PPV for diabetic macula-involving TRD. Further studies are needed to confirm our preliminary findings.

    Clinical trial register: NCT00690768

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