POST OPERATIVE BLEED AFTER PARS PLANA VITRECTOMY WITH PRE-OPERATIVE INTRA VITREAL BEVACIZUMAB VS INTRAVITREAL RANIBIZUMAB IN DIABETIC PATIENTS WITH ADVANCE DIABETIC EYE DISEASE
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Keywords
Bevacizumab, Ranibizumab,vitreous hemorrhage, advanced diabetic eye disease, pars plana vitrectomy
Abstract
Intravitreal Bevacizumab (Avastin) and Ranibizumab (Patizra) both are vascular endothelial growth factor(VEGF) inhibitors that are developed against vascular endothelial growth factor isoforms which is the driving force behind ischemic neo vascularization in diabetic eye disease. The objective of our study is to evaluate the efficacy of pre-operative intravitreal Bevacizumab Vs Intravitreal Ranibizumab on post operative vitreous cavity bleed after three port 23 gauge pars-plana vitrectomy (PPV).
Patients & Methods
This study was conducted in the department of Ophthalmology Services Hospital Lahore from January 2024 to June 2024.Fourty (40) patients with advance diabetic eye disease were included in this study for three port 23 gauge pars plana vitrectomy (PPV) with pre operative intravitreal Bevacizumab or Avastin(1.25 mg/0.05 ml) and Intravitreal Ranibizumab one week prior to PPV and incidence as well as severity of post operative vitreous cavity bleeding was recorded on day one, day three and day seven along with severity grading from no visible bleed to mild and severe based on fundus examination .
Results
Mean patient age in our study was 57.36±3.62 years . Out of 20 eyes with pre operative intravitreal Bevacizumab , 15 patients (75%) had no bleeding, 3 (15%) were documented as mild and 2(10%) were documented ashaving severe post operative vitreous cavity bleed whrereas in the pre operative intravitreal Ranibizumab group out of 20 eyes , 16(80%) had no bleeding , 3(15%) had mild to moderate bleeding and 1(5%) were documented as severe post operative vitreous cavity bleeding in post operative followups.
Conclusion
Intravitreal Bevacizumab and Ranibizumab administered preoperatively to patients undergoing PPV for advance diabetic eye disease were found to be equally effective in minimizing post operative vitreous bleed in patients with ADED.
References
2) Shaikh A, Shaikh F, Shaikh ZA, Ahmed J. Prevalence of Diabetic Retinopathy and influence factors among newly diagnosed Diabetics in Rural and Urban Areas of Pakistan: Data analysis from the Pakistan National Blindness & Visual Impairment Survey 2003. Pak J Med Sci. 2008;24:774–779.
3) Chaudhary GM. Retinopathy in diabetic patients. Pak J Med Res. 2005;44:82–87
4) Mahar PS, Awan MZ, Manzar N, Memon MS. Prevalence of type-II diabetes mellitus and diabetic retinopathy: the Gaddap study. J Coll Physicians Surg Pak. 2010 Aug 1;20(8):528-32.
5) Kanski JJ. Clinical ophthalmology: a systematic approach. 6th Ed. Philadelphia: Elsevier Limited; 2007. p. 582.
6) Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wisconsin Epidemiologic Study of Diabetic Retinopathy, XII: The 14-year incidence and progression of diabetic retinopathy and associated risk factors in type 1 diabetes. Ophthalmology. 1998;105:1801–1815.
7) Rizzo S, Genovesi-Ebert F, Di Bartolo E, Vento A, Miniaci S, Williams G. Injection of intravitreal bevacizumab (Avastin) as a preoperative adjunct before vitrectomy surgery in the treatment of severe proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophtalmol. 2008;246:837–842.
8) Ishikawa K, Honda S, Tsukahara Y, Negi A. Preferable use of intravitreal bevacizumab as a pretreatment of vitrectomy for severe proliferative diabetic retinopathy. Eye (Lond). 2009;23(1):108-111.
9) Chen E, Park CH. Uses of intravitreal bevacizumab as a preoperative adjunct for tractional retinal detachment repair in severe proliferative diabetic retinopathy. Retina. 2006;26(6):669–670.
10) El-Batarny AM. Intravitreal bevacizumab as an adjunctive therapy before diabetic vitrectomy. Clin Ophthalmol. 2008;2(4):709–716.
11) Faisal SM, Tahir MA, Cheema AM, Anjum MI. Pars plana vitrectomy in vitreous hemorrhage with or without Intravitreal Bevacizumab a comparative overview. Pak J Med Sci. 2018;34(1):221-225. doi:10.12669/pjms.341.12683
12) Feng J, Li B, Wen J, Jiang Y. Preoperative timing of intravitreal bevacizumab injection for proliferative diabetic retinopathy patients. Ophthalmic research. 2018;60(4):250-7.
13) Mota SE, Nuñez-Solorio SM. Experience with intravitreal bevacizumab as a preoperative adjunct in 23-G vitrectomy for advanced proliferative diabetic retinopathy. European journal of ophthalmology. 2010 Nov;20(6):1047-52
14) Pérez-Argandoña E, Verdaguer J, Zacharías S, González R. Preoperative intravitreal bevacizumab for proliferative diabetic retinopathy patients undergoing vitrectomy-First update. Medwave. 2019 Jan 25;19(01)
15) Tsubota K, Usui Y, Wakabayashi Y, Suzuki J, Ueda S, Goto H. Effectiveness of prophylactic intravitreal bevacizumab injection to proliferative diabetic retinopathy patients with elevated preoperative intraocular VEGF in preventing complications after vitrectomy. Clinical Ophthalmology (Auckland, NZ). 2019;13:1063.
16) Smith JM, Steel DH. Anti‐vascular endothelial growth factor for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy. Cochrane Database of Systematic Reviews. 2015(8).
17) Al-Kharashi A, Galbinur T, Mandelcorn ED, Muni RH, Nabavi M, Kertes PJ. The adjunctive use of pre-operative intravitreal bevacizumab in the setting of proliferative diabetic retinopathy. Saudi Journal of Ophthalmology. 2016 Oct 1;30(4):217-20.
18) Demir M, Oba E, Can E, Kara O, Cinar S. Effect of bevacizumab injection before vitrectomy on intravitreal hemorrhage in pseudo phakic patients with proliferative diabetic retinopathy. Ophthalmology and eye Diseases. 2013 Jan;5:OED-S12352
19) Liang X, Zhang Y, Wang JX, Wang LF, Huang WR, Tang X. Intravitreal ranibizumab injection at the end of vitrectomy for diabetic vitreous hemorrhage (Observational Study). Medicine. 2019 May;98(20
20) Avery RL, Pearlman J, Pieramici DJ, Rabena MD, Castellarin AA, Ma’an AN, Giust MJ, Wendel R, Patel A. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology. 2006 Oct 1;113(10):1695-705.
21) Zhao Y, Singh RP. The role of anti-vascular endothelial growth factor (anti-VEGF) in the management of proliferative diabetic retinopathy. Drugs in context. 2018;7..
22) Nagpal, M., Choudhry, N., Mehrotra, N., Nagpal, K., & Lingam, G. (2011). Efficacy of Preoperative Bevacizumab Injection for Vitrectomy in Diabetic Tractional Retinal Detachment
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Muhammad Hamza Shahid
Senior Registrar Department of Ophthalmology Services Institute of Medical Sciences / Services Hospital Lahore
Shamshad Ali
Senior Registrar Department of Ophthalmology Services Institute of Medical Sciences / Services Hospital Lahore
Farooq Ahmed
Assistant Professor Department of Ophthalmology Services Institute of Medical Sciences / Services Hospital Lahore
Muhammad Mueen Bhatti
Associate professor Department of Ophthalmology Lahore Medical & Dental College Lahore
Rana Naveed Iqbal
Senior Registrar, Department of Ophthalmology Services Institute of Medical Sciences / Services Hospital Lahore
Khawaja Mohsin Ihsan
Professor of Ophthalmology Services Institute of Medical Sciences / Services Hospital Lahore
Saqib Siddiq
Professor of Ophthalmology Services Institute of Medical Sciences / Services Hospital Lahore