use of intravitreal bevacizumab or triamcinolone acetonide as a preoperative adjunct to vitrectomy for vitreous haemorrhage in diabetics injeção intravítrea de bevacizumabe ou triancinolona como adjuvantes da vitrectomia posterior no tratamento da hemorragia vítrea em diabéticos

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ID: 147942
2013
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Abstract
PURPOSE: To evaluate the effect of preoperative intravitreal bevacizumab (IVB) or triamcinolone (IVT) on the rate of early postvitrectomy hemorrhage in proliferative diabetic retinopathy (PDR). METHODS: Eligible eyes were assigned randomly to 1 of 3 groups: the IVB group received 1.25 mg bevacizumab, the IVT group received 4,0mg triamcinolone and the control group underwent a sham procedure. The primary outcome measure was the incidence of early postvitrectomy hemorrhage. Secondary outcome measures included changes in visual acuity (BCVA) and adverse events. RESULTS: Twenty and seven eyes, 9 in each group were randomized. The incidence of vitreous hemorrhage was lower in the IVB group (p=0.18). Postoperative vitreous hemorrhage at 1 month also was less in the IVB group compared with the control group (p > 0.05). The rate of bleeding immediately after surgery was higher in IVT group with 4 (44.4%) cases. The overall mean visual acuity was 1.72 ± 0.37 logMAR preoperatively and 1.32 ± 0.73 logMAR in 6 months after surgery. Accessing visual acuity by group evidenced that the IVB group had initial mean logMAR VA of 1.87 and 1.57 logMAR VA at the six months (p = 0.84). In IVT group, initial mean VA was 1.75 logMAR and 0.96 logMAR VA at six months (p < 0.001). And in control group, the initial mean VA was 1.85 logMAR and 1.57 logMAR VA at six months (p= 0.34). CONCLUSION: Intravitreal injection of bevacizumab 1 week before vitrectomy seems to reduce the incidence of early postvitrectomy hemorrhage in diabetic patients. There was a better visual acuity outcome in the triamcinolone group.
OBJETIVO: Avaliar o efeito no pré-operatório da injecao intravítrea de bevacizumab (IVB) ou triancinolona (IVT) sobre a taxa de hemorragia precoce pos-vitrectomia na retinopatia diabética proliferativa. MÉTODOS: Os olhos foram distribuídos em três grupos: IVB - 1,25 mg bevacizumab, IVT - 4,0 mg de triancinolona e o grupo controle - simulação da injeção. O objetivo primário foi a avaliação da incidência da hemorragia precoce pós-vitrectomia. Os objetivos secundários incluíram mudanças na acuidade visual corrigida e eventos adversos relacionados à injeção. RESULTADOS: Dos Vinte e sete olhos, 9 foram randomizados em cada grupo. A incidência de hemorragia vítrea foi menor no grupo IVB (P=0,18). A hemorragia vítrea em 1 mês também foi menor no grupo IVB (P > 0,05). A taxa de sangramento pós-operatório imediato foi maior no grupo IVT com 4 (44,4%) dos casos. A média da acuidade visual (AV) foi de 1,72 ± 0,37 logMAR no pré-operatório e 1,32 ± 0,73 logMAR em 6 meses após a cirurgia. Analisando a AV por grupo evidenciamos que o grupo IVB tinha inicialmente AV média logMAR de 1,87 e AV logMAR de 1,57 em seis meses (p = 0,84). No grupo IVT, a média inicial de AV foi de 1,75 logMAR e 0,96 logMAR em seis meses (p < 0,001). E no grupo controle, a média inicial foi de 1,85 logMAR e 1,57 logMAR no seis meses (p = 0,34). CONCLUSÃO: A injeção intravítrea de bevacizumab antes da vitrectomia parece diminuir a incidência de hemorragia vítrea precoce pós-vitrectomia em diabéticos. Houve um melhor resultado na acuidade visual no grupo da triancinolona.
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Authors ;Daniel Araújo Ferraz;Celso Morita;Rony Carlos Preti;Vinicius Paganini Nascimento;Otacílio Oliveira Maia Junior;André Carvalho de Barros;Beatriz Sayuri Takahashi;Walter Yukihiko Takahashi
Journal the european journal of neuroscience
Year 2013
DOI
DOI not found
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72802013000100003
Keywords
Diabetic retinopathy vitrectomy

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