Bevacizumab pretreatment and long-acting gas infusion on vitreous clear-up after diabetic vitrectomy

PURPOSE: To evaluate the effects of bevacizumab pretreatment combined with intravitreal infusion of C3F8 10% on the clearance speed of early postoperative vitreous hemorrhage in diabetic vitrectomy for eyes with active fibrovascular proliferation. DESIGN: Prospective, nonrandomized, comparative case study. METHODS: Sixteen eyes (15 patients) that underwent primary pars plana vitrectomy for active proliferative diabetic retinopathy (PDR) were prospectively enrolled with a follow-up period of six months or more. These cases received an intravitreal injection of bevacizumab (1.25 mg/0.05 ml) one week prior to surgery and intravitreal C3F8 10% infusion during surgery. The severity of intraoperative bleeding, vitreous clear-up time, percentage of prolonged vitreous clear-up (> or = three weeks), and recurrent hemorrhage respectively were compared with those in a control group (24 eyes in 24 patients) that received gas infusion alone. RESULTS: The severity of intraoperative bleeding was significantly lower in the study group than in the control group. Vitreous clear-up time for the study group and the control group was 7.2 +/- 5.6 days and 15.2 +/- 11.4 days, respectively (P = .04). Prolonged vitreous clear-up time (> or = three weeks) was observed in one of 16 (6.3%) and nine of 24 (37.5%) of the cases, respectively (P = .03). Early recurrent vitreous hemorrhage rates in the two groups were zero of 16 (0%) and one of 24 (4.2%), respectively (P = .41). Multiple logistic regression analyses showed that bevacizumab pretreatment reduced vitreous clear-up time. CONCLUSIONS: Bevacizumab pretreatment combined with C3F8 10% infusion could be an effective adjunct to vitrectomy in accelerating postoperative vitreous clear-up for eyes with active PDR.