The Effect of Adjunctive Intravitreal Bevacizumab for Preventing Postvitrectomy Hemorrhage in Proliferative Diabetic Retinopathy
The Effect of Adjunctive Intravitreal Bevacizumab for Preventing Postvitrectomy Hemorrhage in Proliferative Diabetic Retinopathy
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DOI：
10.1016/j.ophtha.2011.03.036
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发表时间：
2011-11-01
期刊：
影响因子：
13.7
通讯作者：
Park, Kyu Hyung
中科院分区：
文献类型：
--
作者：
Ahn, Jeeyun;Woo, Se Joon;Park, Kyu Hyung
目的：评估术前和术中玻璃体内注射贝伐单抗（IVB）对增殖性糖尿病视网膜病变（PDR）玻璃体切除术后玻璃体出血（VH）发生率的影响。设计：前瞻性、随机、临床试验。参与者：91例接受睫状体平坦部玻璃体切除术（PPV）治疗PDR相关并发症的患者的107只眼入选。107例患者被随机分配到第1组或第2组（PPV前1 - 14天玻璃体内注射1.25 mg/0.05 ml贝伐珠单抗），第2组（PPV结束时玻璃体内注射1.25 mg/0.05 ml贝伐珠单抗），或组3主要结果测量：主要结果是早期（4周）复发VH的发生率。次要结果指标为术后6个月玻璃体清除的初始时间（ITVC）和最佳矫正视力（BCVA）。结果：第1、2和3组早期复发性VH的发生率分别为22.2%、10.8%和32.4%（P = 0.087）。亚组配对分析显示，与组3相比，组2的早期VH发生率显著降低（P = 0.026）。第1、2和3组晚期复发VH的发生率分别为11.1%、16.2%和14.7%（P = 0.813）。第1、2和3组的ITVC分别为26.4 +/- 42.5天、10.3 +/- 8.2天和25.2 +/- 26.1天。第2组的ITVC明显短于第1组和第3组（分别为P = 0.045和P = 0.015）。3组术后6个月的最佳矫正视力无显著性差异（P = 0.418）。结论：本研究未发现大量证据支持在PDR玻璃体切除术中连续使用术前IVB来减少VH的术后复发。对于考虑连续使用IVB的选定病例，术中给药似乎是减少术后VH的更好选择。财务披露：作者在本文讨论的任何材料中没有专有或商业利益。Ophthalmology 2011;118：2218-2226（C）2011，美国眼科学会。
Objective: To assess the effects of preoperative and intraoperative intravitreal bevacizumab (IVB) injection on the incidence of postoperative vitreous hemorrhage (VH) after vitrectomy for proliferative diabetic retinopathy (PDR).Design: Prospective, randomized, clinical trial.Participants: One hundred seven eyes of 91 patients undergoing pars plana vitrectomy (PPV) for the management of PDR-related complications were enrolled.Methods: One hundred seven cases were assigned randomly to either group 1 (intravitreal 1.25 mg/0.05 ml bevacizumab injection 1 to 14 days before PPV), group 2 (intravitreal 1.25 mg/0.05 ml bevacizumab injection at the end of PPV), or group 3 (no IVB injection).Main Outcome Measures: The primary outcome was the incidence of early (4 weeks) recurrent VH. Secondary outcome measures were the initial time of vitreous clearing (ITVC) and best-corrected visual acuity (BCVA) at 6 months after surgery.Results: The incidences of early recurrent VH were 22.2%, 10.8%, and 32.4% in groups 1, 2, and 3, respectively (P = 0.087). A subgroup pairwise analysis showed significantly decreased early VH incidence in group 2 compared with that of group 3 (P = 0.026). The incidences of late recurrent VH were 11.1%, 16.2%, and 14.7% in groups 1, 2, and 3, respectively (P = 0.813). The ITVC in groups 1, 2, and 3 were 26.4 +/- 42.5 days, 10.3 +/- 8.2 days, and 25.2 +/- 26.1 days, respectively. The ITVC was significantly shorter in group 2 compared with that in groups 1 and 3 (P = 0.045 and P = 0.015, respectively). The BCVA at 6 months after surgery did not differ significantly among the 3 groups (P = 0.418).Conclusions: This study found no substantial evidence to support the adjunctive use of preoperative IVB to reduce postoperative recurrence of VH in vitrectomy for PDR. For select cases in which adjunctive IVB use is considered, intraoperative administration seems to be the better option for reducing postoperative VH. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2011;118:2218-2226 (C) 2011 by the American Academy of Ophthalmology.