Effectiveness of prophylactic intravitreal bevacizumab injection to proliferative diabetic retinopathy patients with elevated preoperative intraocular VEGF in preventing complications after vitrectomy

Figures & data

Table 1 Patient demographics and baseline ocular and clinical findings

Characteristics	No. (%) or median (range)
Number of patients	33
Number of eyes	42
Gender: male/female	21/12 (63%/36%)
Age (years)	56 (37–82)
HbA1c (%)	7.6 (5.9–11.6)
Hypertension	15 (37%)
Dyslipidemia	5 (12%)
Serum creatinine (mg/dL)	0.78 (0.47–11.9)
Oral anticoagulant	8 (24%)
Preoperative BCVA (LogMAR)	1.59 (0.22 to +3.00)
Intraocular pressure (mmHg)	14.7 (9–26)
Lens status: phakia/pseudophakia	35/7 (83%/17%)
Previous PRP	26 (62%)
Vitreous hemorrhage	42 (100%)
Neovascularization of the iris	4 (10%)
Traction retinal detachment	16 (38%)
Fibrovascular proliferation	21 (50%)
Neovascularization of the disc	35 (83%)

Abbreviations: Hb, hemoglobin A1c; BCVA, best-corrected visual acuity; LogMAR, logarithm of minimal angle of resolution; PRP, pan-retinal photocoagulation.

Table 2 Surgical procedures and outcome

Characteristics	No. (%) or median (range)
Cataract surgery (PEA+IOL)	31 (74%)
SF6 tamponade	6 (14%)
Final lens status: phakia/ pseudophakia	4/38 (10/90%)
Final anatomic success	42 (100%)
Postoperative BCVA (logMAR)	0.22 (−1.57 to +2.00)
BCVA improvement by 3 lines or more	37 (88%)
Early VH (<4 weeks)	2 (5%)
Onset of early postoperative VH (days postop)	1
Late VH (>4 weeks)	5 (12%)
Onset of late postoperative VH (days postop)	110 (50–200)
Postoperative NVG	0 (0%)
Progressive retina detachment	0 (0%)
Complication of IVB	0 (0%)
Follow-up period after surgery (months)	14.7 (12–18)

Abbreviations: PEA, phacoemulsification and aspiration; IOL, intraocular lens; SF₆, sulfur hexafluoride; BCVA, best-corrected visual acuity; logMAR, logarithm of minimal angle of resolution; VH, vitreous hemorrhage; NVG, neovascular glaucoma; IVB, intravitreal bevacizumab; postop, after vitrectomy.

Table 3 VEGF concentrations and patients selected for IVB injection

Characteristics	No. (%) of eyes, mean, or median (range)
Mean vitreous VEGF concentration (pg/mL)	774.5 (20–3,560)
Time until VEGF result was available (days)	6.4 (3–14)
Eyes with vitreous VEGF levels exceeding 1,000 pg/mL	11 (26%)
Eyes receiving IVB injection	11 (26%)
Time from vitrectomy to IVB injection (days)	11.0 (7–17)

Abbreviations: VEGF, vascular endothelial growth factor; IVB, intravitreal bevacizumab.

Table 4 IVB and clinical data with or without IVB in PDR

Characteristics	IVB (n=11)	Non IVB (n=31)	P-value
Number of eyes	11 (26%)	31 (74%)
Age (years)	58 (44–71)	55 (37–82)	0.58
HbA1c (%)	8.0 (6–10.8)	7.1 (5.9–11.6)	0.06
Hypertension	7 (64%)	8 (26%)	0.02
Dyslipidemia	2 (18%)	3 (10%)	0.45
Serum creatinine (mg/dL)	0.93 (0.54–1.7)	1.86 (0.47–11.9)	0.17
Oral anticoagulant	2 (18%)	6 (19%)	0.93
Pre operative BCVA (LogMAR)	1.65 (0.22–3)	1.58 (0.22–3)	0.28
Intraocular pressure (mmHg)	13.5 (9–19)	14.5 (9–26)	0.21
Previous PRP	6 (55%)	20 (65%)	0.56
Neovascularization of the iris	1 (9%)	3 (10%)	0.95
Traction retinal detachment	4 (36%)	12 (39%)	0.76
Fibrovascular proliferation	4 (36%)	17 (55%)	0.29
Neovascularization of the disc	8 (72%)	29 (94%)	0.12
Mean vitreous VEGF levels (pg/mL)	1,761 (1080–2180)	412 (20–998)	<0.01
Early postoperative VH (<4 weeks)	0 (0%)	2 (6%)	0.99
Late postoperative VH (>4 weeks)	2 (18%)	4 (13%)	0.66
Postoperative NVG	0 (0%)	0 (0%)
BCVA improvement by 3 lines or more	10 (91%)	27 (87%)	0.91
Follow-up period after surgery (months)	13.2 (12–17)	15.2 (12–18)	0.10

Abbreviations: IVB, intravitreal bevacizumab; PDR, proliferative diabetic retinopathy; Hb, hemoglobin A1c; BCVA, best-corrected visual acuity; LogMAR, logarithm of minimal angle of resolution; PRP, pan-retinal photocoagulation; VEGF, vascular endothelial growth factor; VH, vitreous hemorrhage; NVG, neovascular glaucoma.