Intraoperative bleeding during vitrectomy for diabetic tractional retinal detachment with versus without preoperative intravitreal bevacizumab (IBeTra study).

AIMS: To compare the amount of intraoperative intraocular bleeding in patients with diabetes with macula-involving tractional retinal detachment (TRD) undergoing pars plana vitrectomy (PPV) with and without preoperative intravitreal bevacizumab (IVB) injection. METHODS: An institutional study was carried out with consecutive patients with diabetic retinopathy and macula-involving TRD of recent (3 months) onset who were randomly assigned to PPV only (PPV group) or PPV combined with one IVB (1.5 mg/0.06 ml) injection 2 weeks prior to surgery (bevacizumab (BEV)/PPV group). All patients underwent 23-gauge PPV 3 weeks after baseline. The main outcome measure was erythrocyte count in the fluid retrieved from the vitrectomy cassette using a Neubauer counting chamber. RESULTS: The study included 20 patients. The mean erythrocyte count was 14,865x10(3) (SD 19,332x10(3); median 4,500x10(3)) cells in the BEV/PPV group, and 176,240x10(3) (SD 108,375x10(3); median 166,600x10(3)) cells in the PPV group. The mean erythrocyte count was significantly lower in the BEV/PPV group than in the PPV group (p<0.0001). No major adverse events were identified. CONCLUSION: Preoperative IVB injection was associated with reduced intraocular bleeding during 23-gauge PPV for diabetic macula-involving TRD. Further studies are needed to confirm our preliminary findings. TRIAL REGISTRATION NUMBER: NCT00690768.

Complex distribution of renal vessels

The retroperitoneal lumbar vessels should be immediately recognized during urological, vascular and radiologicalmedical procedures. Few studies have tried to define an exact pattern for the lumbar vasculature andmost of the anatomical descriptions suggest the presence of a regular pattern. Nevertheless, for the renal bloodvessels, despite the described regular pattern, several anatomical variations have interested anatomists for morethan a century. Taking into account that there is a constant need for reviewing this anatomy due to the advancesin surgical and/or uroradiological procedures techniques, we describe a complex variation of the renalblood vessels found during the dissection routine in our laboratory. A male cadaver, aged 65 years, embalmedwith 10% formalin solution presented, on the left side, two renal arteries arising from the abdominal aorta,both of them entering the kidney on the hilar region. From the hilar region of the left kidney, there were alsotwo tributary renal veins, which join together 3.0 cm from the hilus, before draining into the inferior venacava. These two tributary veins were large in diameter, and made a loop around the two renal arteries and alsothe ureter. No anatomical variations were found on the right side. This is a complex anatomical variation of therenal vessels which might have functional implications once the venous loop described might be a compressionfactor for the renal arteries and for the ureter.