KEYWORDS: Advanced diabetic eye disease, Avastin, Bevacizumab, Vitrectomy.
Diabetic retinopathy is one of the most common causes of visual impairment in 20 - 64 years old individuals.1 In Pakistan, the prevalence of Diabetes Mellitus in adult population greater than 25 years of age is about 9%.2 The occurrence of diabetic retinopathy in subjects having diabetes mellitus is estimated to be in between 15.3% to 28.9% according to some studies.3,4 The prevalence of advanced diabetic eye disease among the patients of diabetic retinopathy was 1.74% in a study conducted in Gaddap.5 Advanced diabetic eye disease is characterized by dense non clearing vitreous hemorrhage and/or tractional retinal detachment.6
Advanced diabetic eye disease is induced by retinal ischemia that leads to retinal neovascularization.
In a comparative study the reduction of bleeding was up to 64% in a group of patients who received intravitreal Avastin before vitrectomy as compared to those who did not receive Avastin.7 The rational of our study is to provide health care system adequate knowledge about the usefulness of intravitreal injection of Avastin before vitrectomy in order to reduce the potential intraoperative bleeding during vitrectomy surgery for the management of advanced diabetic eye disease. Reduction in bleeding will reduce surgical time and will provide clear visibility during surgery.
The sample size included 56 eyes of 56 patients with advanced diabetic eye disease. Patients having either gender, aging between 45-65 years with non-resolving vitreous hemorrhage for three months even after treatment secondary to diabetes were included in the study however those with previous vitrectomy, any major surgery with in past 3 months, uncontrolled hypertension, known coagulation abnormalities and current use of anticoagulant medications were excluded.
POLICY IMPLICATIONS: The Intra Vitreal injection of Triamcinolone Acetonide should be given to all patients undergoing vitrectomy for advanced diabetic eye disease, since it has definite therapeutic efficacy in improving vision and maintaining the improved vision.
In this stage (advanced diabetic eye disease) patients suffer from severe visual loss.26.
The patients recruited for the randomized clinical trial were chosen from those with features of proliferative diabetic retinopathy with vitreous haemorrhage (advanced diabetic eye disease) by indirect ophthalmoscopy and B-scan ultrasonography.80 patients were found eligible.