This retrospective, interventional case series, aimed to assess the effectiveness of intravitreal bevacizumab (IVB) in vitreous haemorrhage secondary to proliferative diabetic retinopathy. The primary outcome was the rate of vitrectomy (PPV) after IVB, with secondary outcomes the number of IVB injections and pan-retinal photocoagulation (PRP) performed within one year of follow-up, as well as changes in visual acuity (VA). Data was recorded for up to two years if no PPV took place within the first year. Patients were sub-divided into treatment-naïve and into those with previous PRP. The case note review covered the period from January 2008 to January 2015 and exclusion criteria included eyes with previous IVB or PPV, less than one year of follow-up, concurrent diabetic macular oedema (DMO) and neovascular glaucoma. Of the 111 included eyes, 49.5% required PRP, 31.6% required only injections and 18.9% required PPV after one year. The indications for vitrectomy were recurrent vitreous haemorrhage (VH)/non-clearing VH (NCVH), NCVH/TRD and tractional retinal detachment (TRD). The overall average number of injections in this period was two (one to nine) and 11.7% (13) eyes required a single injection; 69/111 eyes required two years of follow-up, of which 62.3% had PRP, 23.3% had only IVB (average 3.1 injections) and 14.5% required PPV, after additional treatments with IVB and PRP. In the second year, there were 8.7% eyes that were managed with a single IVB. Visual acuity was documented at presentation and at one year of follow-up. Eyes that required PPV had worse vision at baseline (20/502) and after one year of follow-up (20/155) than those without PPV (20/163 at baseline, and 20/56 at one year). However, there was no significant difference between the two groups. The authors make it clear that this was a natural history of the condition study rather than an attempt to prove the superiority of one treatment over another or to ascertain the optimal frequency and number of IVB (it was used on pro re nata basis here) to achieve resolution of VH. They feel that as 31.6% of eyes were managed with IVB alone and 11.7% required a single injection, there is good indication that some eyes with VH may require minimal intervention in the form of injections rather than PPV. They highlight possible limitations of the study, such as the lack of a control group and the fact that as management was determined by the doctor’s and patient’s preference rather than a set protocol, bias is likely to have been introduced. They recommend a randomised controlled trial to further establish the role of anti-VEGF in VH, with appropriate treatment regimen. 

Intravitreal bevacizumab for the treatment of vitreous haemorrhage due to proliferative diabetic retinopathy.
Parikh RN, Traband A, Kolomeyer AM, et al.
2017; Epub ahead of print.
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Efrosini Papagiannuli

Birmingham and Midland Eye Centre, Birmingham, UK

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