Intravitreal Bevacizumab for the prevention of postoperative proliferative vitreoretinopathy in high-risk patients
Reviewed by Sofia Rokerya

This single- centre observational retrospective study was conducted to evaluate the effect of intravitreal injection of bevacizumab at the time surgery for rhegmatogenous retinal detachment (RRD) repair on postoperative proliferative vitreoretinopathy (PVR) in patients at high risk selected by laser flare photometry. The study cohort included 137 patients who were treated with pars plana vitrectomy and gas tamponade for primary repair of RRD with increased aqueous flare. The study period was between July 2016 and June 2021. From June 2019 IVT bevacizumab was introduced as an adjunct to this surgery. The patients who were operated before this period and did not receive bevacizumab served as controls. The main outcome was the rate of retinal re-detachment due to PVR. Baseline comparable characteristics included gender (p=0.818), age (p=0.704), lens status (p=0.639), and axial length (p=0.511). Median flare value was 22.0 (16.5–36.5) pc/ms in the control group and 28.2 (19.7–41.0) pc/ms in the bevacizumab group (p=0.063). Preop, the eyes treated with bevacizumab were more likely to have macula off RRD (p=0.003), grade B PVR (p=0.038), and worse visual acuity (p=0.004) than controls. Five (9.3%) eyes in the bevacizumab group and 10 (12.0%) eyes in the control group presented with retinal re-detachment due to new retinal breaks, leading to an overall primary anatomic success rate of 79.6% and 57.8%, respectively (p=0.008) The rate of PVR re-detachment was significantly lower in the bevacizumab group (11.1%) than in the control (30.1%) (p=0.012). This difference was more pronounced after adjusting for potential confounding factors (p=0.005); the risk of developing PVR was 4.5-fold higher in controls (95% CI, 1.6–12.8). After adjustment, the final median visual acuity was also significantly higher in eyes treated with bevacizumab (p=0.025) The study provided preliminary evidence that bevacizumab may have a beneficial effect in reducing the risk of PVR-related recurrent RRD and improve visual outcomes in high-risk patients who were selected by laser flare photometry. Further prospective trials are required to confirm these findings. Limitations: Retrospective non- randomised design. Aqueous flare was not measured post-operatively. Differences in surgical techniques for the two groups were not taken into consideration.

Intravitreal injection of Bevacizumab for the prevention of postoperative proliferative vitreoretinopathy in high-risk patients selected by laser flare photometry.
Gahon M, Luc A, Zessler A, et al.
OPHTHALMOLOGICA
2023;246:306–13.