37.
Is there an Evidence for an Adjunctive Intravitreal
Pharmacotherapy in Vitreoretinal Surgery?
Andreas Wedrich, M Velikay-Parel, A. Haas, G. Langmann, B, Vidic (Graz)
Since Machemer`s first vitrectomy in 1971 the development of instruments, surgical tools, tamponades
including the recent developments of sutureless vitrectomy has allowed therapy in a
still increasing number of vitreo-retino-choroidal pathologies with decreasing surgical trauma.
Looking at the success/complication rates of various indications adjuncts to vitreoretinal
surgery seem to be warranted to overcome the limitations of pure mechanical vitrectomy.
These include proliferative vitreoretinopathy (PVR), within this field the induction of posterior
vitreous detachment, submacular hemorrhage and vasoproliferative disease ranging from
retinopathy of prematurity (ROP) to proliferative diabetic retinopathy (PDR)
We performed a pubmed research in the above mentioned fields with a time cut-off December
2007 and selected all clinical studies with adjunctive intravitreal pharmacotherapy for further analysis. The studies found
were then classified according to the evidenc level classification provided by the German “Ärztlichen Zentrum für Qualität
in der Medizin” which has four levels ranging from level 1 for systematic reviews (meta analysis) over a number of randomized
controlled studies to level 4 meaning opinions of respected authorities, based on clinical experience, descriptive studies,
or reports of expert committees.
In the field of PVR we found four evidenc level 2 reports studying daunorubicin, 5-fluorouracil with high molecular weight
heparin, aspirin-silicone oil and dexamethasone.
In the area of pharmacological induction of PVD so far there is no published evidence level 2 study. This is the same in the
field of the use of recombinant tissue plasminogen activator for submacular hemorrhage and the use of anti-VEGF drugs in
vasoproliferative disease although level 3 studies in these fields show promising results.
Summarizing there is good evidence for the role of adjunctive pharmacotherapy in PVR, but less in other complex fields of
vitreoretinal surgery. Potent drugs are coming up and wait for testing in future high evidence level studies.