Abstract
Introduction: To evaluate the effect of an intravitreal injection of bevacizumab at the time of rhegmatogenous retinal detachment (RRD) surgery, on postoperative proliferative vitreoretinopathy (PVR) in high-risk patients selected by laser flare photometry. Methods: This single-center observational retrospective cohort study included 137 consecutive patients who underwent pars plana vitrectomy and gas tamponade for primary RRD with increased aqueous flare between July 2016 and June 2021. From June 2019, an intravitreal injection of bevacizumab was administered as an adjunct to RRD repair. Patients who underwent surgery before this time and who did not receive intravitreal bevacizumab served as controls. The main outcome was the rate of retinal redetachment due to PVR. Results: The median flare value was 22.0 (16.5–36.5) pc/ms in the control group and 28.2 (19.7–41.0) pc/ms in the bevacizumab group (p = 0.063). Eyes treated with bevacizumab were more likely to have macula-off RRD (p = 0.003), grade B PVR (p = 0.038), and worse visual acuity (p = 0.004) than controls. The rate of PVR redetachment was significantly lower in the bevacizumab group (11.1%) than in the control (30.1%) (p = 0.012). This difference was more pronounced after adjusting for potential confounding factors (p = 0.005); the risk of developing PVR was 4.5-fold higher in controls (95% CI, 1.6–12.8). After adjustment, the final median visual acuity was also significantly higher in eyes treated with bevacizumab (p = 0.025). Conclusion: This pilot study provides preliminary evidence that bevacizumab may reduce the risk of PVR-related recurrent RRD and improve visual outcomes in high-risk patients selected by laser flare photometry.
Journal Section:
Research Article
References
1.
Rowe JA, Erie JC, Baratz KH, Hodge DO, Gray DT, Butterfield L, et al. Retinal detachment in olmsted county, Minnesota, 1976 through 1995. Ophthalmology. 1999 Jan;106(1):154–9.
2.
Charteris DG. Proliferative vitreoretinopathy: pathobiology, surgical management, and adjunctive treatment. Br J Ophthalmol. 1995 Oct;79(10):953–60.
3.
Pastor JC, Rojas J, Pastor-Idoate S, Di Lauro S, Gonzalez-Buendia L, Delgado-Tirado S. Proliferative vitreoretinopathy: a new concept of disease pathogenesis and practical consequences. Prog Retin Eye Res. 2016 Mar;51:125–55.
4.
Chen C, Chen P, Liu X, Li H. Combined 5-fluorouracil and low molecular weight heparin for the prevention of postoperative proliferative vitreoretinopathy in patients with retinal detachment: a meta-analysis. Front Med. 2021;8:790460.
5.
Banerjee PJ, Quartilho A, Bunce C, Xing W, Zvobgo TM, Harris N, et al. Slow-release dexamethasone in proliferative vitreoretinopathy: a prospective, randomized controlled clinical trial. Ophthalmology. 2017 Jun;124(6):757–67.
6.
Falavarjani KG, Hadavandkhani A, Parvaresh MM, Modarres M, Naseripour M, Alemzadeh SA. Intra-silicone oil injection of methotrexate in retinal reattachment surgery for proliferative vitreoretinopathy. Ocul Immunol Inflamm. 2020 Apr;28(3):513–6.
7.
Ahmadieh H, Nourinia R, Ragati Haghi A, Ramezani A, Entezari M, Rahmani G, et al. Oral colchicine for prevention of proliferative vitreoretinopathy: a randomized clinical trial. Acta Ophthalmol. 2015 Mar;93(2):e171–2.
8.
Armstrong D, Augustin AJ, Spengler R, Al-Jada A, Nickola T, Grus F, et al. Detection of vascular endothelial growth factor and tumor necrosis factor alpha in epiretinal membranes of proliferative diabetic retinopathy, proliferative vitreoretinopathy and macular pucker. Ophthalmologica. 1998;212(6):410–4.
9.
Ricker LJAG, Kijlstra A, Kessels AGH, de Jager W, Liem ATA, Hendrikse F, et al. Interleukin and growth factor levels in subretinal fluid in rhegmatogenous retinal detachment: a case-control study. PLoS One. 2011 Apr;6(4):e19141.
10.
Ricker LJAG, Dieudonné SC, Kessels AGH, Rennel ES, Berendschot TTJM, Hendrikse F, et al. Antiangiogenic isoforms of vascular endothelial growth factor predominate in subretinal fluid of patients with rhegmatogenous retinal detachment and proliferative vitreoretinopathy. Retina. 2012 Jan;32(1):54–9.
11.
Citirik M, Kabatas EU, Batman C, Akin KO, Kabatas N. Vitreous vascular endothelial growth factor concentrations in proliferative diabetic retinopathy versus proliferative vitreoretinopathy. Ophthalmic Res. 2012;47(1):7–12.
12.
Ichsan AM, Windy DA, Muhiddin HS, Budu, Massi MN, Islam IC. Comparison between vascular endothelial growth factor and platelet-derived growth factor levels in rhegmatogenous retinal detachment. J Ophthalmol. 2021 Dec;2021:2688837.
13.
Pennock S, Kim D, Mukai S, Kuhnle M, Chun DW, Matsubara J, et al. Ranibizumab is a potential prophylaxis for proliferative vitreoretinopathy, a nonangiogenic blinding disease. Am J Pathol. 2013 May;182(5):1659–70.
14.
Pennock S, Haddock LJ, Eliott D, Mukai S, Kazlauskas A. Is neutralizing vitreal growth factors a viable strategy to prevent proliferative vitreoretinopathy?Prog Retin Eye Res. 2014 May;40:16–34.
15.
Ghasemi Falavarjani K, Hashemi M, Modarres M, Hadavand Khani A. Intrasilicone oil injection of bevacizumab at the end of retinal reattachment surgery for severe proliferative vitreoretinopathy. Eye. 2014 May;28(5):576–80.
16.
Hsu J, Khan MA, Shieh W-S, Chiang A, Maguire JI, Park CH, et al. Effect of serial intrasilicone oil bevacizumab injections in eyes with recurrent proliferative vitreoretinopathy retinal detachment. Am J Ophthalmol. 2016 Jan;161:65–70.e1-2.
17.
Zhao X-Y, Xia S, Wang E-Q, Chen Y-X. Efficacy of intravitreal injection of bevacizumab in vitrectomy for patients with proliferative vitreoretinopathy retinal detachment : a meta-analysis of prospective studies. Retina. 2018 Mar;38(3):462–70.
18.
Kon CH, Asaria RH, Occleston NL, Khaw PT, Aylward GW. Risk factors for proliferative vitreoretinopathy after primary vitrectomy: a prospective study. Br J Ophthalmol. 2000 May;84(5):506–11.
19.
Asaria RHY, Kon CH, Bunce C, Charteris DG, Wong D, Luthert PJ, et al. How to predict proliferative vitreoretinopathy. Ophthalmology. 2001 Jul;108(7):1184–6.
20.
Sala-Puigdollers A, Fernández I, Coco RM, Sanabria MR, Rodríguez de la Rúa E, Ruiz-Moreno JM, et al. External validation of existing formulas to predict the risk of developing proliferative vitreoretinopathy: the retina 1 project; report 5. Retina. 2013 Sep;33(8):1519–27.
21.
Schröder S, Muether PS, Caramoy A, Hahn M, Abdel-Salam M, Diestelhorst M, et al. Anterior chamber aqueous flare is a strong predictor for proliferative vitreoretinopathy in patients with rhegmatogenous retinal detachment. Retina. 2012 Jan;32(1):38–42.
22.
Hoerster R, Hermann MM, Rosentreter A, Muether PS, Kirchhof B, Fauser S. Profibrotic cytokines in aqueous humour correlate with aqueous flare in patients with rhegmatogenous retinal detachment. Br J Ophthalmol. 2013 Apr;97(4):450–3.
23.
Conart J-B, Kurun S, Ameloot F, Tréchot F, Leroy B, Berrod J-P. Validity of aqueous flare measurement in predicting proliferative vitreoretinopathy in patients with rhegmatogenous retinal detachment. Acta Ophthalmol. 2017 Jun;95(4):e278–83.
24.
Küchle M, Nguyen NX, Hannappel E, Beck W, Ho ST, Naumann GO. Tyndallometry with the laser flare cell meter and biochemical protein determination in the aqueous humor of eyes with pseudoexfoliation syndrome. Ophthalmologe. 1994 Oct;91(5):578–84.
25.
Machemer R, Aaberg TM, Freeman HM, Irvine AR, Lean JS, Michels RM. An updated classification of retinal detachment with proliferative vitreoretinopathy. Am J Ophthalmol. 1991 Aug;112(2):159–65.
26.
Herbort CP, Tugal-Tutkun I, Neri P, Pavésio C, Onal S, LeHoang P. Failure to integrate quantitative measurement methods of ocular inflammation hampers clinical practice and trials on new therapies for posterior uveitis. J Ocul Pharmacol Ther. 2017 May;33(4):263–77.
27.
Tousi A, Hasanpour H, Soheilian M. Intravitreal injection of bevacizumab in primary vitrectomy to decrease the rate of retinal redetachment: a randomized pilot study. J Ophthalmic Vis Res. 2016 Sep;11(3):271–6.
28.
Girard P, Mimoun G, Karpouzas I, Montefiore G. Clinical risk factors for proliferative vitreoretinopathy after retinal detachment surgery. Retina. 1994;14(5):417–24.
29.
Yoshino Y, Ideta H, Nagasaki H, Uemura A. Comparative study of clinical factors predisposing patients to proliferative vitreoretinopathy. Retina. 1989;9(2):97–100.
30.
Tseng W, Cortez RT, Ramirez G, Stinnett S, Jaffe GJ. Prevalence and risk factors for proliferative vitreoretinopathy in eyes with rhegmatogenous retinal detachment but no previous vitreoretinal surgery. Am J Ophthalmol. 2004 Jun;137(6):1105–15.
31.
Bonnet M. Clinical risk factors of vitreoretinal proliferations in rhegmatogenous retinal detachment. J Fr Ophtalmol. 1994;17(8–9):530–40.
32.
Pastor JC. Proliferative vitreoretinopathy: an overview. Surv Ophthalmol. 1998 Aug;43(1):3–18.
33.
Pastor JC, de la Rúa ER, Martín F. Proliferative vitreoretinopathy: risk factors and pathobiology. Prog Retin Eye Res. 2002 Jan;21(1):127–44.
34.
London NJS, Kaiser RS, Khan MA, Alshareef RA, Khuthaila M, Shahlaee A, et al. Determining the effect of low-dose isotretinoin on proliferative vitreoretinopathy: the DELIVER trial. Br J Ophthalmol. 2019 Sep;103(9):1306–13.
35.
Mitry D, Awan MA, Borooah S, Siddiqui MAR, Brogan K, Fleck BW, et al. Surgical outcome and risk stratification for primary retinal detachment repair: results from the Scottish Retinal Detachment study. Br J Ophthalmol. 2012 May;96(5):730–4.
36.
Lei H, Rheaume M-A, Kazlauskas A. Recent developments in our understanding of how Platelet-Derived Growth Factor (PDGF) and its receptors contribute to proliferative vitreoretinopathy. Exp Eye Res. 2010 Mar;90(3):376–81.
37.
Lei H, Velez G, Hovland P, Hirose T, Gilbertson D, Kazlauskas A. Growth Factors outside the PDGF family drive experimental PVR. Invest Ophthalmol Vis Sci. 2009 Jul;50(7):3394–403.
38.
Pennock S, Kazlauskas A. Vascular endothelial growth factor A competitively inhibits Platelet-Derived Growth Factor (PDGF)-dependent activation of PDGF receptor and subsequent signaling events and cellular responses. Mol Cell Biol. 2012 May;32(10):1955–66.
39.
Zhu Q, Ziemssen F, Henke-Fahle S, Tatar O, Szurman P, Aisenbrey S, et al. Vitreous levels of bevacizumab and vascular endothelial growth factor-A in patients with choroidal neovascularization. Ophthalmology. 2008 Oct;115(10):1750–5. e1.
40.
Mietz H, Heimann K. Onset and recurrence of proliferative vitreoretinopathy in various vitreoretinal disease. Br J Ophthalmol. 1995 Oct;79(10):874–7.
© 2023 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2023
You do not currently have access to this content.
