Use of intravitreal bevacizumab or triamcinolone acetonide as a preoperative adjunct to vitrectomy for vitreous haemorrhage in diabetics / Injeção intravítrea de bevacizumabe ou triancinolona como adjuvantes da vitrectomia posterior no tratamento da hemorragia vítrea em diabéticos

PURPOSE: To evaluate the effect of preoperative intravitreal bevacizumab (IVB) or triamcinolone (IVT) on the rate of early postvitrectomy hemorrhage in proliferative diabetic retinopathy (PDR). METHODS: Eligible eyes were assigned randomly to 1 of 3 groups: the IVB group received 1.25 mg bevacizumab, the IVT group received 4,0mg triamcinolone and the control group underwent a sham procedure. The primary outcome measure was the incidence of early postvitrectomy hemorrhage. Secondary outcome measures included changes in visual acuity (BCVA) and adverse events. RESULTS: Twenty and seven eyes, 9 in each group were randomized. The incidence of vitreous hemorrhage was lower in the IVB group (p=0.18). Postoperative vitreous hemorrhage at 1 month also was less in the IVB group compared with the control group (p > 0.05). The rate of bleeding immediately after surgery was higher in IVT group with 4 (44.4%) cases. The overall mean visual acuity was 1.72 ± 0.37 logMAR preoperatively and 1.32 ± 0.73 logMAR in 6 months after surgery. Accessing visual acuity by group evidenced that the IVB group had initial mean logMAR VA of 1.87 and 1.57 logMAR VA at the six months (p = 0.84). In IVT group, initial mean VA was 1.75 logMAR and 0.96 logMAR VA at six months (p < 0.001). And in control group, the initial mean VA was 1.85 logMAR and 1.57 logMAR VA at six months (p= 0.34). CONCLUSION: Intravitreal injection of bevacizumab 1 week before vitrectomy seems to reduce the incidence of early postvitrectomy hemorrhage in diabetic patients. There was a better visual acuity outcome in the triamcinolone group.

OBJETIVO: Avaliar o efeito no pré-operatório da injecao intravítrea de bevacizumab (IVB) ou triancinolona (IVT) sobre a taxa de hemorragia precoce pos-vitrectomia na retinopatia diabética proliferativa. MÉTODOS: Os olhos foram distribuídos em três grupos: IVB - 1,25 mg bevacizumab, IVT - 4,0 mg de triancinolona e o grupo controle - simulação da injeção. O objetivo primário foi a avaliação da incidência da hemorragia precoce pós-vitrectomia. Os objetivos secundários incluíram mudanças na acuidade visual corrigida e eventos adversos relacionados à injeção. RESULTADOS: Dos Vinte e sete olhos, 9 foram randomizados em cada grupo. A incidência de hemorragia vítrea foi menor no grupo IVB (P=0,18). A hemorragia vítrea em 1 mês também foi menor no grupo IVB (P > 0,05). A taxa de sangramento pós-operatório imediato foi maior no grupo IVT com 4 (44,4%) dos casos. A média da acuidade visual (AV) foi de 1,72 ± 0,37 logMAR no pré-operatório e 1,32 ± 0,73 logMAR em 6 meses após a cirurgia. Analisando a AV por grupo evidenciamos que o grupo IVB tinha inicialmente AV média logMAR de 1,87 e AV logMAR de 1,57 em seis meses (p = 0,84). No grupo IVT, a média inicial de AV foi de 1,75 logMAR e 0,96 logMAR em seis meses (p < 0,001). E no grupo controle, a média inicial foi de 1,85 logMAR e 1,57 logMAR no seis meses (p = 0,34). CONCLUSÃO: A injeção intravítrea de bevacizumab antes da vitrectomia parece diminuir a incidência de hemorragia vítrea precoce pós-vitrectomia em diabéticos. Houve um melhor resultado na acuidade visual no grupo da triancinolona.

Evaluation of visual outcome of intravitreal injection avastin [bevacizumab] in proliferative diabetic retinopathy with vitreous hemorrhage

To report the visual outcome after intravitreal injection Avastin [Bevacizumab] in proliferative diabetic retinopathy with vitreous heamorrhage with 1 year followup. It was analytical observational type of study. The study was carried out at Eye department Abbasi Shaheed Hospital from July 2008-June 2010. 100 patients were selected through non-probability consecutive sampling technique from the diabetic eye clinic who presented with proliferative diabetic retinopathy and vitreous hemorrhage .Patients with vitreous hemorrhage in one eye and proliferative diabetic retinopathy or bilateral vitreous hemorrhage were included in the study. B scans were done in dense vitreous hemorrhage to exclude tractional retinal detachment. History was taken regarding duration of diabetes and decreased vision. Detailed ocular examination including visual aquity, intraocular pressure, detailed anterior segment examination on slitlamp and direct and indirect ophthalmoscopy was done. Other eye was also examined to exclude proliferative diabetic retinopathy in that eye. Patients were counselled for intravitreal injection Avastin [Bevacizumab]. After detailed examination patients were admitted in the ward and Intravitreal injection Avastin 1.25mg/0.05 ml was given in sterile environment in the operation theatre using fully aseptic technique. Patients were discharged on moxifloxacin eye drops and steroid antibiotic combination ointment at night time. Patients were followed up very next day, after 1 week, 6 weeks, 3 months, six months and 1 year. Snellens best corrected visul aquity was recorded at each visit along with fundus biomicroscopy and fundus flourescine angiography wherever possible. Other eye was also treated with intravitreal injection Avastin-[Bevacizumab], grid or focal laser treatment or panretinal fundus photocoagulation as and when required. 140 eyes of 100 patients were treated with intravitrea linjection Avastin [Bevacizumab] Followup ranged from 1st postoperative day to 1 year. Baseline visual aquity was PL/PR -perception of hand movement in 99 eyes, finger counting-6/60 in 27 eyes and 6/36 in 14 eyes. Improvement of vision was observed at 2 weeks. VA finger counting -6/60 was seen in 43 eyes, 6/36-6/18 in 63 eyes and there was no improvment in 14 eyes. After 6 month follow up FC-6/60 was seen in 18 eyes, 6/36-6/18 in 88 eyes, 6/12-6/9 was seen in 20 eyes. There was still no improvment in 14 eyes due to exudative maculopathyin 10 eyes and ischeamic maculopathy in 4 eyes. At one year followup VA finger counting-6/60 was seen in 14 eyes, 6/36- 6/18 in 87 eyes and 6/12-6/9 in 25 eyes. There was still no improvement in 14 eyes due to the above mentioned reasons. Vitreous hemorrhage resolved completely in 44 eyes, while 16 eyes had residual vitreous heamorrhage. Regression of neovascularization was observed in 120 eyes. Intravitreal injection Avastin [Bevacizumab] was repeated twice or thrice 6 weeks apart in patients with residual vitreous hemorrhage 11.4% [16 patients] and in patients with neovascularization at disc or elsewhere after 6 weeks of first injection30% [42 patients]. Some visual improvement was observed after repetition of the injection. Complications like cells in anterior chamber were seen in 5% of the eyes. Acute rise of intraocular pressure was seen in 15% eyes subconjunctival hemorrhage in 30% eyes. All the complications were managed successfully. It was concluded that Avastin is a promising drug for proliferative diabetic retinopathy. It is a very helping and simple procedure keeping in mind the long periods of absorption of vitreous hemorrhage and avoiding vitrectomy. Panretinal photocoagulation is recommended after clearance of vitreous hemorrhage

Relaçäo entre aneurisma intracraniano e hemorragia intra-ocular: apresentaçäo de 4 casos / Cerebral aneurism and intravitreous hemorrhage relation: report of 4 cases

Säo discutidos os mecanismos para hemorragia intra-vítrea em casos de hemorragia cerebral por aneurisma. Os pacientes que lograrem recuperar-se do ponto de vista neurológico têm bom prognóstico para recuperaçäo visual mesmo que necesitem vitrectomia