Secondary rhegmatogenous retinal detachment following intravitreal bevacizumab in patients with vitreous hemorrhage or tractional retinal detachment
secondary to Eales' disease.
Patients were classified as having advanced diabetic eye disease when they develop complications of proliferative diabetic retinopathy like vitreous hemorrhage, rubeosis iridis, neovascular glaucoma or tractional retinal detachment
. Patients were classified as having diabetic maculopathy if there was leakage from microaneurysms, exudation or hemorrhages at macula.
Control (n = 9) PDR (n = 8) Age (years) 53.9 [+ or -] 12.5 47.5 [+ or -] 10.7 Gender (male/female) 4:5 4:4 FBG (mmol/L) 6.0 [+ or -] 0.7 9.7 [+ or -] 0.9 HbA1C (%) -- 9.1 [+ or -] 1.3 Lensstatus 3/6 3/5 (phakic/pseudophakic) Indication for surgery VH -- 8 (100%) TRD -- 2 (25%) IVC (n = 9) p value Age (years) 50.9 [+ or -] 11.8 >0.05 Gender (male/female) 4:5 >0.05 FBG (mmol/L) 9.8 [+ or -] 2.0 <0.01 HbA1C (%) 8.5 [+ or -] 1.2 >0.05 Lensstatus 4/5 >0.05 (phakic/pseudophakic) Indication for surgery VH 9 (100%) >0.05 TRD 3 (33%) >0.05 VH: vitreous hemorrhage; TRD: tractional retinal detachment
. TRD: tractional retinal detachment
Tractional retinal detachment
following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy.
Dilated fundus examination revealed pale optic disc and old tractional retinal detachment
involving macular area in right eye resulting in blindness in that eye (Figure 2A) which was undiagnosed.
This study provides objective proof that the intravitreal injection of Avastin (bevacizumab) before vitrectomy for vitreous hemorrhage and tractional retinal detachment
facilitates the surgery by reducing the surgical time, decrease the intraoperative bleeding and need for hemoststic measures and reduces the incidence of iatrogenic retinal tears.
Without treatment, however, they can cause complications such as macular edema, exudative and tractional retinal detachment
, intravitreal hemorrhage, and neovascular glaucoma.
Abbreviations AC: Anterior chamber AHFG: Anterior hyaloid fibrovascular proliferation ERM: Epiretinal membrane EVALP: Evaluation protocol EVRS: European Vitreoretinal Society Eyesi: Eye simulator (manufactured by VRmagic company) f/u: Follow-up g: Gauge GRT: Great retinal tears ILM: Inner limiting membrane mPa x s: Millipascal seconds med.: Medical P(D)VR: Proliferative (diabetic) vitreoretinopathy PFCL: Perfluorocarbon liquids PPV: Pars plana vitrectomy PVD: Posterior vitreous detachment SLP: Scheimpflug lens photography SO: Silicone oil SOT: Silicone oil tamponade SOP: Standard operation procedure TRD: Tractional retinal detachment
VB: Vitreous body.
Tractional retinal detachment
in addition to the symptoms of stage V was determined as stage VI.
Although these are not the tractional membranes encountered in the eyes with diabetic tractional retinal detachment
, they may be similarly difficult to peel.
One of the most common complication vitreo-retinal surgeons come across after retinal detachment surgery and other vitreo-retinal procedures is PVR, which is basically a maladapted repair process of the retinal wound; which results in the formation of epiretinal membranes due to immune and retinal cells proliferation and the cause of tractional retinal detachment
in such cases.
(20) However, there remains the fact that combination therapy with intravitreal antiVEGF injection may result in vitreoretinal fibrosis and tractional retinal detachment
. (23) Laser photocoagulation and cryotherapy were also the most common treatment modalities in the current case series, especially in earlier stage disease.