Bevacizumab reduces need for vitrectomy in PDR patients with vitreous haemorrhage

Intravitreal bevacizumab (IVB) injections induce short-lived visual benefit but ease the need for vitrectomy in proliferative diabetic retinopathy (PDR) patients with vitreous haemorrhage (VH) who had undergone prior complete panretinal photocoagulation (PRP), a recent study has found.

Researchers conducted a multicentre cohort study of 40 patients (mean age 53.1±9.1 years, 56.8 percent men) contributing 44 eyes treated with IVB and 89 patients (mean age 59.2±10.0 years, 69.6 percent men) contributing 92 untreated eyes. Main outcomes were the cumulative rate of vitrectomy and spontaneous clear-up compared between groups.

Eleven eyes in the IVB group needed vitrectomy as opposed to 39 eyes in the control group (25 percent vs 42 percent; p=0.049). The resulting cumulative probability of vitrectomy remained significantly lower in IVB eyes throughout the follow-up period.

Kaplan-Meier survival curves confirmed that over 24 months of follow-up, IVB eyes showed significantly less need for vitrectomy than controls (p=0.005). The time until vitrectomy was likewise longer in the IVB group (p=0.003).

In terms of VH clearance, IVB eyes showed significantly higher clear-up rates relative to controls (88 percent vs 80 percent; p=0.024) that occurred much earlier (6.5 vs 13.1 months; p=0.008). Similarly, 1-month best-corrected visual acuity was better in the IVB eyes (p=0.002), though such effect was attenuated at the 6-, 12-, and 24-month follow-ups.  

“IVB can induce more rapid clearance of VH and short-term visual gain in eyes with VH, despite prior full PRP, and may be carefully considered as an adjunctive treatment in these patients with caution of its side effects and risks in deferring vitrectomy,” the researchers said.