A Randomized clinical trial comparing Intravitreal bevacizumab with intravitreal triamcinolone in the reduction of intraoperative haemhorrage in diabetic vitrectomy

Session Details

Session Title: Free Paper Session 8: Vitreoretinal Surgery III

Session Date/Time: Friday 08/09/2017 | 08:00-09:30

Paper Time: 08:48

Venue: Room 111

First Author: : A.Ramezani IRAN

Co Author(s): :    B. Safarpour Lima   M. Entezari   H. Nikkhah   H. Fateh Moghaddam   M. Yaseri                 

Abstract Details

Purpose:

To compare the use of preoperative intravitreal bevacizumab (IVB) with intravitreal triamcinolone (IVT) in the reduction of intraoperative haemhorrage in patients undergoing vitrectomy for complications of proliferative diabetic retinopathy (PDR).

Setting:

Ophthalmology department of Imam Hossein Medical centre. Eye Negah Hospital. Ophthalmic Epidemiology Research centre of Shahid Beheshti University of Medical Sciences.

Methods:

In this randomized clinical trial, 141 eyes of 141 patients (mean age 54 ± 10 years) with PDR who were candidate for vitrectomy entered the study. Cases were randomly assigned to two groups: 74 eyes received 1.25 mg IVB and 67 eyes received 2 mg IVT, respectively, 8.8 ± 4.8 and 8.8 ± 3.2 days before vitrectomy. Demographic data, intraoperative findings and intraoperative maneuvers were recorded. The severity of intraoperative bleeding (classified as no, mild and severe) was compared between the groups as the main outcome measure. The frequency of applied endodiathermy was the second outcome.

Results:

The groups were matched regarding final diagnosis (VH only, localized TRD, and active fibrovascular proliferation with or without TRD), preoperative fresh vitreous haemhorrage, intraoperative complexity score, time of vitrectomy, number of tool exchange, performing segmentation as well as use of scissors, perfluorocarbon and internal tamponade. The number of eyes with no intraoperative bleeding as well as the frequency of mild and severe intraoperative bleeding (21 versus 21, 30 versus 27, and 12 versus 5, in the IVB and IVT groups, respectively) did not differ significantly between the groups (P = 0.701). The mean number of all types of bleeding was 1.6 ± 1.4 and 1.7 ± 1.5 times in IVB and IVT groups, respectively (P = 0.596). The difference in the number of applied endodiathermy was also insignificant between the groups, 25 versus 27 in the IVB and IVT groups, respectively (P = 0.408).

Conclusions:

In conclusion, preoperative adjunct injections of IVB and IVT have similar effect on prevention of intraoperative bleeding in patients undergoing vitrectomy for PDR complications. Based on the patients’ characteristics, therefore, either one may be chosen considering the availability and various potential side effects of each drug. In eyes with extensive fibrovascular tissues, one may prefer preoperative injection of IVT to avoid any progression in traction that may occur after IVB.

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