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Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy
  1. J F Arevalo1,
  2. M Maia2,
  3. H W Flynn, Jr3,
  4. M Saravia4,
  5. R L Avery5,
  6. L Wu6,
  7. M Eid Farah2,
  8. D J Pieramici5,
  9. M H Berrocal7,
  10. J G Sanchez1
  1. 1
    Retina and Vitreous Service, Clinica Oftalmológica Centro Caracas, Caracas, Venezuela
  2. 2
    Universidade Federal de São Paulo, Departamento de Oftalmologia, Instituto da Visão, São Paulo, Brazil
  3. 3
    Retina and Vitreous Service, Bascom Palmer Eye Institute, Miami, FL, USA
  4. 4
    Hospital Universitario Austral, Buenos Aires, Argentina
  5. 5
    California Retina Consultants and Research Foundation, Santa Barbara, CA, USA
  6. 6
    Instituto de Cirugia Ocular, San Jose, Costa Rica
  7. 7
    University of Puerto Rico, San Juan, Puerto Rico
  1. J F Arevalo, Clinica Oftalmológica Centro Caracas, Edif. Centro Caracas PH-1, Av. Panteon, San Bernardino, Caracas 1010, Venezuela; arevalojf2020{at}


Aims: The aim of this study was 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 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 type 1 diabetes mellitus (DM), and two patients had type 2 DM. Patients had a mean age of 39.5 years (range 22–62 years). In the current study, all patients used insulin administration and had poor glycaemic control (mean HbA1c 10.6%). Time from injection to TRD was a mean of 13 days (range 3–31 days). Mean best correct visual acuity (BCVA) at TRD development or progression was logarithm of the minimal angle of resolution (LogMAR) 2.2 (range 1.0–2.6) (mean Snellen equivalent hand motions; range 20/200 to light perception), a statistically significant worsening compared with 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 0.2–2.0) (mean Snellen equivalent 20/160; range 20/32 to counting fingers), a statistically significant improvement compared with TRD BCVA (p = 0.002).

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

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  • Competing interests: R L Avery and D J Pieramici are consultants for Genentech. The other authors have no proprietary or financial interest in any products or techniques described in this article.

  • Funding: Supported in part by the Foundation for Science Support from Sao Paulo (FAPESP), São Paulo – SP, Brazil, the Arevalo-Coutinho Foundation for Research in Ophthalmology (FACO), Caracas, Venezuela, and the California Retina Research Foundations, Santa Barbara, CA, USA.