Hassan Mortada (Cairo, Egypt)

Advantages:

Preoperative intravitreal Avastin injection produces significant reduction of retinal neovascularization. This dramatic effect may be related to its activity against all isoforms of VEGF. However, intravitreal Avastin injection is not without complications. It may lead to contraction of the fibrovascular tissue with subsequent production or aggravation of traction retinal detachment or its conversion to combined traction / rhegmatogenous RD. Avastin may also aggravate retinal and/or optic disc ischemia. The optimal time for Avastin to produce its beneficial effect without risk is not yet determined.

Methods:

72 eyes with active proliferative diabetic retinopathy underwent PPV 24 hours following intravitreal Avastin injection (1.25 mg): 44 eyes had traction RD with macular threatening or involvement, 20 eyes had combined traction / rhegmatogenous RD and 8 eyes had fibrovascular tissue covering & distorting the macula. Whenever possible eyes had color and fluorescein angiography before and 24 hours after Avastin injection. The vitrectomy was combined with phacoemulsification + PCIOL in 66 eyes. All eyes underwent either 20 or 23 G vitrectomy. Unimanual or bimanual delamination was used to remove the fibrovascular tissue completely. Following retinal reattachment with PFCL, the basal vitreous gel was excised; endolaser PRP was performed and the eyes were filled with SF6 or silicone oil.

Effectiveness / Safety:

Color and fluorescein angiography shows significant regression of neovascularization, significant decrease of leakage, no fresh bleeding and no aggravation of retinal detachment. Surgery was technically easier: minimal or no bleeding during delamination, many epicenters peeled with blunt dissection. The incidence of postoperative bleeding was 12/72 eyes (16.7%).

Take home message:

24 hours are sufficient for Avastin to produce its beneficial effect without risk adverse effects.