Preoperative bevacizumab reduces complications, surgical time in patients with diabetic TRD

This study assessed intravitreal bevacizumab as an adjunct prior to vitrectomy in eyes with tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR).

Study design

This prospective multicenter 2-year trial randomized 214 eyes to receive preoperative intravitreal bevacizumab or sham injection prior to small-gauge pars plana vitrectomy for diabetic TRD. Primary outcome measures included degree of intraoperative bleeding, total surgical time, early postoperative vitreous hemorrhage and mean change in BCVA at 12 months.

Outcomes

The bevacizumab group experienced significantly less intraoperative bleeding (31.3% vs. 51.7%; P=0.001) and iatrogenic retinal breaks (34.3% vs. 58.9%; P=0.001) than eyes in the sham group. Surgical time was reduced in the treatment group and approached statistical significance (71.3 vs. 83.6 minutes; P=0.061). While there was no difference in visual acuity outcome, eyes in the bevacizumab group had significantly less early postoperative vitreous hemorrhage (28.4% vs. 42.8%; P=0.028).

Limitations

Since this was a multicenter surgical study with multiple surgeons, there was no standardized surgical approach, which may have influenced the results. In addition, heterogeneity in the pathology complexity could have affected the major outcomes measures (intraoperative and postoperative bleeding, retinal breaks, surgical time).

Clinical significance

This large prospective randomized controlled trial demonstrated measurable intra- and postoperative benefits for preoperative anti-VEGF therapy in eyes with diabetic tractional detachment undergoing small-gauge vitrectomy. Although final visual acuity was not impacted, reduction in intraoperative complications and surgical time suggest that preoperative anti-VEGF should be strongly considered in eyes undergoing this surgery.