scholarly journals Intravitreal bevacizumab improves the clearance of vitreous haemorrhage and visual outcomes in patients with proliferative diabetic retinopathy

2019 ◽  
Vol 4 (1) ◽  
pp. e000390 ◽  
Author(s):  
Joonas Wirkkala ◽  
Risto Bloigu ◽  
Nina Maria Hautala
Keyword(s):  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Average Rate ◽  
Real Life ◽  
Intravitreal Bevacizumab ◽  
Visual Outcome ◽  
Vitreous Haemorrhage ◽  
Panretinal Photocoagulation ◽  
Kaplan Meier ◽  
Real Life Data

ObjectiveTo evaluate the occurrence of vitreous haemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR) and the efficacy of intravitreal bevacizumab (IVB) for VH in 5-year real-life data.Methods and analysis850 adult patients with type 1 (T1D) or type 2 diabetes (T2D) with PDR were screened for VH. The effect of IVB was evaluated by the clearage of VH and the change in best corrected visual acuity (BCVA). The rates of VHs, reinjections, macular oedema, complications, additional treatments and outcomes of spontaneous resorption, panretinal photocoagulation or pars plana vitrectomy (PPV) for VH were also investigated.ResultsVH occurred in 16% of patients with T1D and 9% of patients with T2D with PDR. 336 VHs in 140 eyes of 103 patients were documented. VH was cleared in 92% of cases in less than 3 months by the initial IVB. IVB was superior to other treatment methods in shortening the time for clearance of VH (Kaplan-Meier, p<0.0001). The average rate of IVB reinjections was 1.7±1.1 and the reinjection interval was 7.2±3.9 weeks. BCVA increased 0.73±0.04 logarithm of the minimum angle of resolution units after IVB (generalised estimating equations, p=0.0004). In 5 years, the patients had 2.2±2.7 recurrence of VHs. A simultaneous 72% decrease in the rate of PPVs was documented (p<0.0001).ConclusionVH occurs mostly in patients with T1D. The therapeutic effect of IVB for VH was significant and led to improved clearance of VH and visual outcome. Moreover, IVB prevented persistent and recurrent VHs and decreased the need for costly PPV.

scholarly journals Comparison of Visual Outcomes between Panretinal Photocoagulation and Panretinal Photocoagulation Plus Intravitreal Bevacizumab in Proliferative Diabetic Retinopathy Patients Treated at Northen Zonal Hospital

2020 ◽  
pp. 34-43
Author(s):  
Filemon Darabe ◽  
William Makupa
Keyword(s):  
Diabetic Retinopathy ◽  
Retinal Detachment ◽  
Proliferative Diabetic Retinopathy ◽  
Intravitreal Bevacizumab ◽  
Vitreous Hemorrhage ◽  
Visual Outcome ◽  
Panretinal Photocoagulation ◽  
Pan Retinal Photocoagulation ◽  
The Mean ◽  
Retinal Photocoagulation

Introduction: Diabetic retinopathy is one of the rigorous microvascular complications of diabetes mellitus is the significant cause of visual impairment and consequently blindness affecting about 36% of the diabetic population. Diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) are two prime manifestations of DR that are responsible for visual morbidity. The basis of the treatment in PDR is Laser photocoagulation as accomplished by Diabetic retinopathy treatment study (DRS) and early treatment diabetic retinopathy study (ETDRS) for the last two decades. The dawn of intravitreal anti-VEGF agents has revolutionized the management of diabetic eye disease for more than the last decade. The aim of the study is to compare the visual outcomes of diabetic retinopathy patients between pan-retinal photocoagulation and pan-retinal photocoagulation plus intravitreal Bevacizumab. Methodology: A hospital-based cross-section study using medical record information for all DR patients treated by PRP and IVB at the KCMC eye. Data were analyzed using SPSS version 20. Results: A number of 204 patients were included in the study. The mean age was 59.26 (SD=9.6) years; 75.4% were male. Most of the patients 71.1% are from Arusha and Kilimanjaro. Among all, 51% had PRP alone and the duration of Diabetes was 5-10 years in the majority. The mean VA for PRP alone was 0.89 (SD=0.89) before treatment while it was 1 (SD=0.99) in PRP plus Bevacizumab. At 3 months after treatment VA for PRP alone was 0.947 (SD=0.93) and 0.96 (SD=1.01) for PRP plus Bevacizumab. The mean difference was not statistically significant. VA improved by 49% and it deteriorated by 27.7%. The majority had early proliferated DR 49.7%, 42.8% high risk proliferated DR and advanced proliferated DR was 7.5%. The complications were found in 5.6% and they included: vitreous hemorrhage (4.6%) and retinal detachment (1%) in PRP plus Bevacizumab and none in PRP alone. Conclusion: With respect to this study there is no significant difference in visual outcome for PRP alone and PRP plus injection Bevacizumab, though PRP plus Bevacizumab in treatment of DR had better visual outcome over PRP alone. PRP plus injection Bevacizumab is associated with a higher and early rate of regression of active NVs than PRP alone in patients with PDR. Further studies will be needed to determine whether IVB plus PRP is a satisfactory treatment for the prevention of vision-threatening complications such as vitreous hemorrhage and tractional retinal detachment.

scholarly journals Risk factors for recurrent vitreous haemorrhage in patients with proliferative diabetic retinopathy.

2019 ◽  
Author(s):  
Marc BAGET-BERNALDIZ ◽  
Pere Romero-Aroca ◽  
Joaquin Mercado-Gonzalez ◽  
Angel Bautista-Perez ◽  
Núria Soler-Lluís ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Tobacco Consumption ◽  
Vitreous Haemorrhage ◽  
Lower Limbs ◽  
Smoking History ◽  
Diabetic Patients ◽  
Panretinal Photocoagulation ◽  
Systemic Complications ◽  
Urine Albumin

Abstract Background : To investigate which demographic and clinical factors are related to the presence of recurrent vitreous haemorrhage in a population of diabetic patients diagnosed with proliferative diabetic retinopathy [PDR]. Methods: This was a retrospective review-based study. We studied 285 eyes from 165 patients with PDR. We recorded age, gender, type of diabetes mellitus [DM] , type of DM treatment, history of hypertension and body mass index, panretinal photocoagulation status and the presence of concomitant anticoagulant or antiplatelet treatment. We evaluated the mean glycosylated haemoglobin, mean haemoglobin, the urine albumin to creatinine ratio and the estimated glomerular filtration rate in each patient. In addition, we recorded the smoking history [pack-years] and the systemic complications related to DM. We used the logistic regression analysis to study which independent variables were significantly related to the presence of recurrent vitreous haemorrhage. Results: In total, 183 eyes [64%] with PDR had vitreous haemorrhage, of which 68 [37%] underwent recurrent vitreous haemorrhage. In our study, tobacco consumption [OR= 1.21, 95% CI, 1.10- 1.32, P <0.001], duration of diabetes [OR= 1.03, 95% CI, 1.0-1 .07 P = 0.04] and haemoglobin level [OR= -0.24 , 95% CI, -0.16, -0.06 , P <0 .001] had an independently significant associaton with recurrent vitreous haemorrhage. There was a positive correlation between pack-years consumed and the number of vitreous haemorrhages [r=0.339; p<0.001]. In addition, patients with diabetic polineuropathy, myocardial infarction and ischemia in lower limbs had more vitreous haemorrhage events [p<0.001]. Conclusion s : In our study, those patients with PDR who smoked, with longer duration of their diabetes, anaemia and that had previously suffered from cardiovascular events were more prone to suffer from recurrent vitreous haemorrhage.

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