O R I G I N A L R E S E A R C H Intravitreal bevacizumab as an adjunctive therapy before diabetic vitrectomy Ashraf M El-Batarny Assistant Professor of Ophthalmology, Tanta University, Egypt; Chief of Vitreoretinal Service, Magrabi Eye and Ear Hospital, Muscat, Sultanate of Oman Correspondence:Ashraf M El-Batarny Magrabi Eye and Ear Hospital, PO Box 513, P C 112, Muscat, Sultanate of Oman Email elbatarny@hotmail.com Purpose: To evaluate the effect of intravitreal injection of Avastin, bevacizumab (IVA) on diabetic vitrectomy and on the postoperative course. Methods: Thirty patients undergoing diabetic vitrectomy were distributed to standard vitrec- tomy (group 1) or vitrectomy with preoperative IVA (group 2). Bevacizumab was injected 5 to 7 days before surgery. Patients of both groups were matched as much as possible according to surgical indication and preoperative visual acuity. Main outcome measures were the feasibility of surgery and the postoperative complications. Feasibility of surgery was evaluated through recording surgical time, intraoperative bleeding, use of endodiathermy, relaxing retinotomies, use of perﬂuorocarbon liquid (PFCL) and silicone oil tamponade. Results: Follow up ranged between 7 and 18 months. There was signiﬁcant reduction of mean surgical time, bleeding frequency, and diathermy use in group 2 compared to group 1. The rate of PFCL use and relaxing retinotomies were less in group 2 in comparison to group 1. Gas or air was used in 80% of patients in group 2 while silicone oil represented 60% of group 1. Postoperative visual acuity improvement was highly signiﬁcant in both groups but the differ- ence in both groups was not statistically signiﬁcant. Vision improved in 87% in group 2 and 80% in group 1. Primary anatomical attachment was achieved in 90.3% in group 2 and 86.6% in group 1. Rate of subsequent surgeries and persistent cataract were higher in group 1. Post- operative bleeding was reported in 26.6% of cases in group 1 and none in group 2. In group 2, no complications related to avastin injection or progression of traction were reported during the preoperative period. Conclusion: Preoperative IVA was helpful in achieving the surgical and anatomical goals by reducing the time of surgery, the intraoperative and postoperative bleeding, and the use of silicone oil with subsequent reduction of second surgery. Keywords: intravitreal bevacizumab, proliferative diabetic retinopathy, diabetic vitrectomy, vascular endothelial growth factor, diabetic vitreous hemorrhage Introduction The ﬁrst goal of diabetic vitrectomy is to restore vision. Surgical objectives to achieve this goal are thorough removal of vitreous blood, reattachment of the macula, and removal of cataract. The second and equally important goal of surgery is to stabilize the diabetic neovascular process thereby producing long-term anatomic and visual success. The surgical objectives to accomplish this goal are removal of the vitreous scaffold, removal of the surface ﬁbrovascular proliferation, and endophotocoagulation of the ischemic retina. Eyes in which these surgical objectives are achieved and which have a good 6-month outcome tend to remain stable for many years (Blankenship 1981; Blankenship and Machemer 1985; Meredith 1994). Tractional retinal detachment (TRD) and nonresolving vitreous hemorrhage are common indications for diabetic vitrectomy (Meredith 1994). Intraocular hemorrhage represents a serious event during diabetic vitrectomy. Extensive hemorrhage may prevent the successful conclusion of surgery. The removal of clotted blood may not only extend a preexisting retinal Clinical Ophthalmology 2008:2(4) 709–716 © 2008 El-Batarny, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 709