Mario R. Romano, C. Costagliola, P. Vinciguerra (Milan, Italy)

Advantages:

Intravitreal Bevacizumab is efficacious as pre-operative adjuvant treatment rather than intra-operative, for the management of recurrent postoperative hemorrhages in patients with advanced proliferative diabetic retinopathy (PDR).

Methods:

The patients were divided in two groups: Group A (37 eyes) had IVB (1.25 mg in 0.05 ml) within 3 days before surgery; Group B (34 eyes) had IVB at the end of surgery.

Effectiveness / Safety:

In Group A, intraoperative bleeding occurred in 7 cases (19%), the use of endodiathermy was necessary in 9 patients (24%), relaxing retinotomy was performed on 2 patients (5%). One out of 37 eyes (0.3%) had a postoperative re-bleeding 2 weeks after surgery. In Group B, intraoperative bleeding occurred in 12 cases (35%), the use of endodiathermy was necessary in 14 patients (41%), relaxing retinotomy was performed on 1 patient (3%). Ten out of 34 eyes (29%) had a re-bleeding within one month from the surgery.

Take home message:

The best time to avoid recurrent diabetic VH, after vitrectomy for PDR, is 3 days before the surgery rather than intraoperatively.