ANTICOAGULATION AND CLINICALLY SIGNIFICANT POSTOPERATIVE VITREOUS HEMORRHAGE IN DIABETIC VITRECTOMY

Management in D.R. through prophylactic treatment (maintaining a glycemic level as close as possible to normal, control hypertension <150/85 mmHg, hyperlipidemia) and curative treatment of D.R. does not cure the disease, but may slow the evolution of D.M. and D.R. AntiVEGF agents are indicated as adjuvant therapy in pan-photocoagulation laser and / or vitrectomy in patients with DR to block angiogenesis by inhibiting VEGF. All antiVEGF agents are an effective treatment for the clinically significant macular edema. Photocoagulation laser is a treatment of choice in preproliferative and proliferative DR and an effective treatment of diabetic macular edema. The indications for laser treatment in diabetic retinopathy are related to the incidence, evolution of neovessels, duration of diabetes, HbA1c level, presence of macular edema, stage of DR. The laser for macular lesions reduces the risk of vision loss in the eyes with incipient and moderate non-proliferative DR and macular edema concomitant; the laser should be applied to all patients with clinically significant macular edema. Vitrectomy in proliferative DR is indicated in vitreous hemorrhage, tractional retinal detachment in order to remove the vitreous hermorrhage and excision of tractional preretinal membranes.

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Retina Injury After Dexamethasone Injection Into a Vitrectomized Eye

Journal of VitreoRetinal Diseases ◽

10.1177/2474126420934238 ◽

2020 ◽

Vol 4 (6) ◽

pp. 538-540

Author(s):

Michael S. Elliott ◽

Sandra R. Montezuma

Keyword(s):

Macular Edema ◽

Vitreous Hemorrhage ◽

Signs And Symptoms ◽

Internal Limiting Membrane ◽

Dexamethasone Implant ◽

Intravitreal Dexamethasone Implant ◽

Patient Reported ◽

Clinically Significant ◽

The Right ◽

Intravitreal Dexamethasone

Purpose: This work reports a case of retinal and vitreous hemorrhage after a dexamethasone (Ozurdex, Allergan) intravitreal implant injection to treat clinically significant macular edema (ME) in a patient with moderate nonproliferative diabetic retinopathy. Methods: A 61-year-old woman who had a vitrectomy 3 years prior in the right eye underwent intravitreal dexamethasone implant injection in the right eye. Immediately after the injection, the patient noted numerous floaters, with visual acuity decline from 20/30 before injection, to counting fingers at 3 feet after injection. Dilated examination revealed the dexamethasone implant resting against the retina, just inferior to the inferior arcade. On 360° fundus examination, the retina was found to be flat and attached. Optical coherence tomography of the macula demonstrated that the dexamethasone implant was preretinal, possibly having lifted the internal limiting membrane. Results: Thirty minutes after the injection, the patient reported that her vision was starting to clear. The patient was informed about what had transpired and warned about signs and symptoms of retinal detachment. She canceled her 1-week follow-up appointment because her vision returned to baseline. By 4 weeks post injection, her vision was 20/20 without macular edema. Conclusions: This case represents the first reported instance in which retinal impact by an Ozurdex implant was observed without treatment and vision recovered to baseline.

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ROLE OF INTRAVITREAL BEVACIZUMAB (AVASTIN) INJECTED AT THE END OF DIABETIC VITRECTOMY IN PREVENTING POSTOPERATIVE RECURRENT VITREOUS HEMORRHAGE

Retina ◽

10.1097/iae.0b013e3181d6def0 ◽

2010 ◽

Vol 30 (10) ◽

pp. 1646-1650 ◽

Cited By ~ 25

Author(s):

Rizwan A Cheema ◽

Javed Mushtaq ◽

Wajeeha Al-Khars ◽

Essam Al-Askar ◽

Maheera A Cheema

Keyword(s):

Intravitreal Bevacizumab ◽

Vitreous Hemorrhage ◽

Diabetic Vitrectomy ◽

Recurrent Vitreous Hemorrhage

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Análise da Revisão Cochrane: Anti-fator de Crescimento Vascular Endotelial na Prevenção da Hemorragia Vítrea Pós-Operatória após Vitrectomia por Retinopatia Diabética Proliferativa. Cochrane Database Syst Rev. 2015;8:CD008214.

Acta Médica Portuguesa ◽

10.20344/amp.9437 ◽

2017 ◽

Vol 30 (7-8) ◽

pp. 513 ◽

Cited By ~ 1

Author(s):

David Cordeiro Sousa ◽

Inês Leal ◽

João Costa ◽

António Vaz-Carneiro

Keyword(s):

Systematic Review ◽

Vascular Endothelial Growth Factor ◽

Diabetic Retinopathy ◽

Growth Factor ◽

Proliferative Diabetic Retinopathy ◽

Vitreous Hemorrhage ◽

Vascular Endothelial ◽

Cochrane Systematic Review ◽

Endothelial Growth Factor ◽

Postoperative Vitreous Hemorrhage

Postoperative vitreous hemorrhage is a complication following vitrectomy for proliferative diabetic retinopathy, delaying visual recovery and making fundus examination and disease follow-up more difficult. Anti-vascular endothelial growth factor drugs such as bevacizumab, when injected in the vitreous cavity, reduce vascular proliferation and their use has been proposed to reduce the incidence of postoperative vitreous hemorrhage. The authors of this Cochrane systematic review evaluated all randomized controlled trials on the pre- or intraoperative use of anti-vascular endothelial growth factor to reduce postoperative vitreous hemorrhage occurrence after vitrectomy in patients with proliferative diabetic retinopathy. The results suggested that the use of intravitreal bevacizumab was effective in reducing early postoperative vitreous hemorrhage (i.e. at four weeks) occurrence, with a good safety profile. This work aims to summarize and discuss the findings and clinical implications of this Cochrane systematic review.

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Anti-Vascular Endothelial Growth Factor Therapy as an Adjunct to Diabetic Vitrectomy

The Open Ophthalmology Journal ◽

10.2174/1874364102115010137 ◽

2021 ◽

Vol 15 (1) ◽

pp. 137-143

Author(s):

Mushfig Karimov ◽

Lala Akhundova

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Postoperative Period ◽

Early Postoperative Period ◽

Vitreous Cavity ◽

Control Group ◽

Diabetic Vitrectomy ◽

Clinically Significant ◽

Bevacizumab Injection

Introduction: The purpose of this work is to study the efficacy of the preoperative intravitreal administration of bevacizumab as an adjunct to vitrectomy in patients with Proliferative Diabetic Retinopathy (PDR). Methods: This retrospective comparative study was performed on 118 eyes (118 patients) with proliferative diabetic retinopathy (PDR), which underwent vitrectomy surgery at the Department of Diabetic Eye Disease at Zarifa Aliyeva National Ophthalmology Centre (Baku, Azerbaijan) in 2015-2019. The main group (the bevacizumab group) included 48 eyes with PDR that received intravitreal administration of bevacizumab (Avastin; Genentech Inc., USA) within one week before vitrectomy; the control group included 70 eyes that did not receive a bevacizumab injection for at least 3 months before the vitrectomy. The minimum follow-up was 12 months. Results: In both groups, complete retinal attachment after primary vitrectomy was achieved in all eyes (100%). Clinically significant intraoperative haemorrhage was observed in the preoperative bevacizumab injection group in 31.2% and the control group- 51.4%, p = 0.030. The preoperative bevacizumab injection reduced the risk of clinically significant haemorrhage by 2.3 times and the need for endodiathermy by 2.7 times (p = 0.031 and p = 0.024, respectively). Early vitreous cavity haemorrhage was observed in 15.0% in the bevacizumab group and in 35.5% in the control group (p = 0.038). The preoperative injection of bevacizumab before vitrectomy reduced the risk of vitreous cavity haemorrhage in the early postoperative period by 3.0 times (p = 0.036). Conclusion: The preoperative use of bevacizumab as an adjunct to diabetic vitrectomy can help reduce the incidence of intraoperative and early postoperative vitreous cavity haemorrhage, which leads to better functional results in the early postoperative period. Over the long-term follow-up period, the effect of the preoperative bevacizumab injections decreases.

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Surgical timing and presence of a vitreoretinal fellow on postoperative adverse events following pars plana vitrectomy

European Journal of Ophthalmology ◽

10.1177/1120672118811980 ◽

2018 ◽

Vol 30 (1) ◽

pp. 81-87

Author(s):

Ryan A Shields ◽

Cassie A Ludwig ◽

Matthew A Powers ◽

Jonathan D Tijerina ◽

Ira H Schachar ◽

...

Keyword(s):

Adverse Event ◽

Adverse Events ◽

Pars Plana Vitrectomy ◽

Vitreous Hemorrhage ◽

Adverse Event Rate ◽

Start Time ◽

School Of Medicine ◽

Pars Plana ◽

Independent Risk Factors ◽

Postoperative Vitreous Hemorrhage

Introduction: To evaluate the adverse event rate following pars plana vitrectomy as a function of surgical start time and the presence of a vitreoretinal fellow. Methods: Single-institution retrospective cohort study of patients undergoing pars plana vitrectomy from 1 January 2016 to 31 December 2016 at Stanford University School of Medicine (Palo Alto, CA, USA). Records were reviewed for surgical start time, the presence of vitreoretinal fellow, and postoperative adverse events defined as any finding deviating from the expected postoperative course requiring observation or intervention. Results: A total of 310 pars plana vitrectomies were performed. There was no statistical difference in the rate of any adverse event when comparing cases starting after 16:01 (9/13, 69.2%) and after 12:01 (42/99, 42.4%) to a morning start time (69/198, 34.9%, adjusted p = 0.083). There was a statistically significant increase in the risk of postoperative vitreous hemorrhage with afternoon and evening cases as compared to morning cases (adjusted p = 0.021). In addition, there was no difference in any adverse event with a fellow present (93/244, 38.1%) compared to without (27/66, 40.9%, adjusted p = 0.163). There was a higher risk of postoperative hypotony when a fellow was involved (6.6% vs 0%, p = 0.028), though this difference disappeared after adjusting for confounders (adjusted p = 0.252). There was no difference in the length of surgery with and without a fellow (49 vs 54 min, respectively; p = 0.990). Discussion: Afternoon start time and the presence of a fellow were not independent risk factors for postoperative adverse events.

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ФАКТОРИ РИЗИКУ ВИНИКНЕННЯ ІНТРАОПЕРАЦІЙНИХ ГЕМОРАГІЧНИХ УСКЛАДНЕНЬ ПРИ МІНІ-ІНВАЗИВНОМУ ХІРУРГІЧНОМУ ЛІКУВАННІ ПРОЛІФЕРАТИВНОЇ ДІАБЕТИЧНОЇ РЕТИНОПАТІЇ

Medical Informatics and Engineering ◽

10.11603/mie.1996-1960.2013.4.2245 ◽

2014 ◽

Author(s):

A. M. Ruban

Keyword(s):

Risk Factors ◽

Diabetic Retinopathy ◽

Retrospective Study ◽

Retinal Detachment ◽

Operative Time ◽

Vitreous Hemorrhage ◽

Tractional Retinal Detachment ◽

Class 1 ◽

Diabetic Vitrectomy ◽

Sutureless Vitrectomy

<p class="1">The article presents the risk factors for hemorrhages complications in patients with miniinvasive diabetic vitrectomy. This was a retrospective study of 80 eyes (80 patients) who underwent combined sutureless vitrectomy 23/25G for the complications of proliferative diabetic retinopathy. The main outcome measures were visual outcomes and surgical complications. Indications for the surgery were vitreous hemorrhage and tractional retinal detachment. The main predictive clinical features of hemorrhages complications in diabetic vitrectomy were: exicision of fibrovascular membranes (ф=0,49, p<0,001), hypoglycemia (RR=4,52, 95% CI: 2,28-8,97), (ф=0,48, p<0,001), operative time (>1 hour) (RRP=4,68, 95% CI: 2,80-7,23), combine retinal detachment (RR=4,52, 95% CI: 1,18-17,3).</p>

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