Outcomes of Preoperative Bevacizumab in Diabetics with Nonclearing Vitreous Hemorrhage Without Tractional Detachment - A Quasi-Randomized Retrospective Study

Purpose: To assess whether preoperative bevacizumab (BVZ) in treatment-naive eyes with proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH) without tractional retinal detachment (TRD) leads to lesser macular edema and better visual outcome compared to eyes that do not receive BVZ. Methods: This quasi-randomized retrospective study included 217 treatment-naive eyes with nonclearing VH without TRD that had vitrectomy with or without BVZ and had a minimum 6-months follow-up. Postoperative variables, including visual acuity (BCVA), central macular thickness (CMT) at 1 month, and need for additional anti-VEGF injections till 6 months follow-up, were recorded for analysis. Results: Of the 217 eyes, 107 eyes (49%) received preoperative BVZ and 110 (51%) did not. Groups were comparable in terms of preoperative characteristics. At 1 month, mean CMT was significantly higher in eyes without BVZ (310 +/- 33 mu vs. 246 +/- 34 mu; P < 0.001). The likelihood of developing center-involving DME at 1 month after vitrectomy was 67% lower if the eye received preoperative BVZ (OR = 0.33, 95%CI = 0.18-2.54, P = 0.56). Though BCVA improved significantly in both groups at 1 month, it was 1/3rd of a line better in the BVZ group (beta coefficient = -0.035 logMAR, 95%CI = -0.04 to -0.008 logMAR, P = 0.01). Conclusion: Preoperative BVZ in treatment-naive eyes with PDR and VH but without TRD lead to better macular status and marginally improved vision at 1 month, which was maintained at 6 months. In view of these results, patients may be offered BVZ only when it is readily affordable to them.