17.
Pohl-lecture
Anti-VEGF Assited Vitrectomy in Diabetic Retinopathy
Borja Corcóstegui (Barcelona)
Intravitreal Anti-VEGF and other anti-angiogenic drugs shows promise in the treatment of complications
of diabetic retinopathy (PDR). Not only can be used for macular edema and iris neovascularization,
anti-VEGF can be used for retinal neovascularization, post-vitrectomy recurrent
vitreous hemorrhage, and at the end of vitrectomy to avoid reproliferations and recurrent
bleeding.
To treat retinal neovascularization, 0.05 ml (1.25mg) of Intravitreal Avastin was injected preoperatively
one week prior to vitrectomy in 28 patients with severe PDR. The follow-up period
was at least six months. Pre- and post-injection FA and OCT was performed in 20 eyes. Vitreous
hemorrhage precluded a good visualization in the other 8 eyes. By ophthalmoscopy following
IVA, Avastin appeared to decrease neovascular vessels, shrinkage of the collagen tissue and
decrease the caliber of the retinal vessels. A few cases were shown demonstrating such retinal NV regression. Pos-vitrectomy
recurrent vitreous hemorrhage is relatively frequent (3-7 %) and tipically is a consequence of fibrovascular proliferation
at the sclerotomy site(s). We injected 2.5 mg of Avastin in 12 eyes affected with mild vitreous hemorrhage three times in
three months. In four of these cases, he combined cryotherapy at the three sclerotomy sites with IVA. After 6 months of
follow-up, only 1/12 eyes rebled. To avoid reproliferation and rebleeding at the sclerotomy sites after vitrectomy surgery in
severe PDR, the author injected 2.5mg of Avastin prior to removing the last cannula.
The hig dose was chosen to presumably have a longer half life in the vitreous cavity. The author also assumed that the first
week after surgery is the most critical period to have the anti-angiogenic effect of Avastin. Other potential factors that may
influence reproliferation and rebleeding is the use of 23 and 25 gauge instruments which may decrease scleral irritation
more than conventional entries.
In conclusion, Avastin is very useful as a pre-surgical treatment for PDR and will be used for most of his severe PDR cases
in the future. Avastin appears to be effective in controlling recurrent vitreous hemorrhage in his small cohort and can potentially
help reproliferation at the sclerotomy sites.
References:
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study). Retina.2006 Nov-Dec; 26(9):1006-13.
2. Isaacs TW, Barry C. Rapid resolution of severe disc new vessels in proliferative diabetic retinopathy following a single intravitreal injection of bevacizumab
(Avastin). Clin Experiment Ophthalmol. 2006 Nov; 34(8):802-3.
3. Avery RL, Pearlman J, Pieramici DJ, Rabena MD, Castellarin AA, Nasir MA, Giust MJ, Wendel R, Patel A.Intravitreal bevacizumad (Avastin) in the
treatment of proliferative diabetic retinopthy. Ophthalmology. 2006 Oct; 13(10):1695.e1-15.
4. Mason JO 3rd, Nixon PA, White MF.Intravitreal injection of bevacizumab (Avastin) as adjunctive treatment proliferative diabetic retinopathy. Am
J Ophthalmol. 2006 Oct; 142(4):685-8.
5. Friedlander SM, Welch RM. Vanishing disc neovascularization following intravitreal bevacizumab (Avastin) injection. Arch Ophthalmol. 2006 Sep;
124(9):1365. No Abstract available.