Prospective Study
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World J Diabetes. Oct 15, 2014; 5(5): 724-729
Published online Oct 15, 2014. doi: 10.4239/wjd.v5.i5.724
Perfluorocarbon in vitreoretinal surgery and preoperative bevacizumab in diabetic tractional retinal detachment
J Fernando Arevalo, Martin A Serrano, Juan D Arias
J Fernando Arevalo, From the Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States
J Fernando Arevalo, the Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia
J Fernando Arevalo, Division of Ophthalmology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch 7600, South Africa
Martin A Serrano, Juan D Arias, the Retina and Vitreous Service, Clinica Oftalmologica Centro Caracas, Caracas 1010, Venezuela
Author contributions: Arevalo JF performed all surgeries, designed the study and wrote the manuscript; and Serrano MA and Arias JD assisted during all surgeries and collected data; Serrano MA and Arias JD were also involved in editing the manuscript.
Supported by The Arevalo-Coutinho Foundation for Research in Ophthalmology, Caracas, Venezuela
Correspondence to: J Fernando Arevalo, MD, FACS, Chief of the Vitreoretinal Division, King Khaled Eye Specialist Hospital, Al-Oruba Street, PO Box 7191, Riyadh 11462, Saudi Arabia. arevalojf@jhmi.edu
Telephone: +966-11-48212343860 Fax: +966-1-48212343727
Received: November 28, 2013
Revised: June 26, 2014
Accepted: July 15, 2014
Published online: October 15, 2014
Processing time: 261 Days and 14.3 Hours
Abstract

AIM: To describe the en bloc perfluorodissection (EBPD) technique and to demonstrate the applicability of using preoperative intravitreal bevacizumab during small-gauge vitreoretinal surgery (23-gauge transconjunctival sutureless vitrectomy) in eyes with advanced proliferative diabetic retinopathy (PDR) with tractional retinal detachment (TRD).

METHODS: This is a prospective, interventional case series. Participants included 114 (eyes) with advanced proliferative diabetic retinopathy and TRD. EBPD was performed in 114 eyes (consecutive patients) during 23-gauge vitrectomy with the utilization of preoperative bevacizumab (1.25 mg/0.05 mL). Patients mean age was 45 years (range, 21-85 years). Surgical time had a mean of 55 min (Range, 25-85 min). Mean follow up of this group of patients was 24 mo (range, 12-32 mo). Main outcome measures included best-corrected visual acuity (BCVA), retinal reattachment, and complications.

RESULTS: Anatomic success occurred in 100% (114/114) of eyes. Significant visual improvement [≥ 2 Early Treatment Diabetic Retinopathy Study (ETDRS) lines] was obtained in 69.2% (79/114), in 26 eyes (22.8%) BCVA remained stable, and in 8 eyes (7%) BCVA decreased (≥ 2 ETDRS lines). Final BCVA was 20/50 or better in 24% of eyes, between 20/60 and 20/400 in 46% of eyes, and worse than 20/400 in 30% of eyes. Complications included cataract in 32 (28%) eyes, iatrogenic retinal breaks in 9 (7.8%) eyes, vitreous hemorrhage requiring another procedure in 7 (6.1%) eyes, and phthisis bulbi in 1 (0.9%) eye.

CONCLUSION: This study demonstrates the usefulness of using preoperative intravitreal bevacizumab and EBPD during small-gauge vitreoretinal surgery in eyes with TRD in PDR.

Keywords: Avastin; Intravitreal bevacizumab; Intravitreal injections; Proliferative diabetic retinopathy; Tractional retinal detachment; Perfluorodissection; Minimally invasive vitreoretinal surgery; Vitrectomy

Core tip: En bloc perfluorodissection and preoperative intravitreal bevacizumab use for small-gauge vitrectomy in patients with proliferative diabetic retinopathy and tractional retinal detachment are very useful, the combination reduces complications and operative time. En bloc perfluorodissection and preoperative intravitreal bevacizumab use seems to have many advantages including that the retina remains stable during vitrectomy, better visibility of the ocular structures in the vitreous cavity, immediate reattachment of the retina, bleeding control, subretinal fluid reabsorbsion and drainage, bleeding sites’ tamponade, and easier dissection of epiretinal tissues.