J.ophthalmol.(Ukraine).2021;3:10-14.
http://doi.org/10.31288/oftalmolzh202131014
Received: 08 January 2021; Published on-line: 29 June 2021
Outcomes of aflibercept for post-vitrectomy vitreous hemorrhage in patients with proliferative diabetic retinopathy
O. O. Putienko 1, D. M. Pogorilyi2, V. O. Putienko2
1 SI "The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine»; Odesa (Ukraine)
2 Military Medical Clinical Center, Southern Region; Odesa (Ukraine)
E-mail: alputienko@gmail.com
TO CITE THIS ARTICLE:Putienko OO, Pogorilyi DM, Putienko VO. Outcomes of aflibercept for post-vitrectomy vitreous hemorrhage in patients with proliferative diabetic retinopathy. J.ophthalmol.(Ukraine).2021;3:10-14. http://doi.org/10.31288/oftalmolzh202131014
Background: The incidence of vitreous hemorrhage after vitrectomy for proliferative diabetic retinopathy (PDR) has been reported to vary from 21% to 80%.
Purpose: To assess the efficacy of gas exchange tamponade (GET) in combination with intravitreal aflibercept for post-vitrectomy vitreous hemorrhage in patients with PDR.
Material and Methods: We reviewed the medical records of 47 patients (47 eyes) who developed vitreous hemorrhage after vitrectomy for PDR and received a 20% C3F8 GET in combination with 2.0-mg intravitreal aflibercept (EYLEA®).
Results: At 2 months, examination showed “transparent” vitreous cavity in 43 eyes (91.5%), and vitreous hemorrhage was still present in other 4 eyes (8.6%), including a recurrence in 2 eyes (4.3%). At 6 months, examination showed “transparent” vitreous cavity in 46 eyes (97.9%), and only one eye (2.1%) developed a recurrence of vitreous hemorrhage within two months to six months after primary surgery. At the 2 month follow-up, visual acuity was 0.1 to 0.3 in 24 eyes (51%), better than 0.35 in 17 eyes (36.2%), and lower than 0.1 in only 6 eyes (12.8%). At the 6 month follow-up, visual acuity remained similar to that at month 2, but the number of eyes with visual acuity better than 0.35 increased from 17 to 19.
Conclusion: A 20% C3F8 GET in combination with intravitreal aflibercept is an effective method of treatment for vitreous hemorrhage after vitrectomy in patients with PDR and may be widely used in practice.
Keywords: proliferative diabetic retinopathy, post-vitrectomy vitreous hemorrhage, gas exchange tamponade, aflibercept
Conflict of Interest Statement: The authors declare no conflict of interest which could influence their opinions on the subject or the materials presented in the manuscript.
References
1.Abbate M, Cravedi P, Iliev I. Prevention and treatment of diabetic retinopathy: evidence from clinical trials and perspectives. Curr Diabetes Rev. 2011 May;7(3):190-200.
2.Behrens AW, Uwaydat SH, Hardin JS, Sallam AB. Office-based Air-Fluid Exchange for Diabetic Postoperative Vitreous Cavity Hemorrhage. Med Hypothesis Discov Innov Ophthalmol. Summer 2019;8(2):104-109.
3.Berk Ergun S, Toklu Y, Cakmak HB, Raza S, Simsek S. The effect of intravitreal bevacizumab as a pretreatment of vitrectomy for diabetic vitreous hemorrhage on recurrent hemorrhage. Semin Ophthalmol. 2015 May;30(3):177-80.
4.Steel DHW, Connor A, Habib MS. Entry site treatment to prevent late recurrent postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy. Br J Ophthalmol. 2010 Sep;94(9):1219-25.
5.Shi L, Yi-Fei H. Postvitrectomy diabetic vitreous hemorrhage in proliferative diabetic retinopathy. J Res Med Sci. 2012 Sep;17(9):865-71.
6.Chatziralli I, Dimitriou E, Theodossiadis G, Bourouki E, Bagli E, Kitsos G, Theodossiadis P. Intravitreal ranibizumab versus vitrectomy for recurrent vitreous haemorrhage after pars plana vitrectomy for proliferative diabetic retinopathy: a prospective study. Int Ophthalmol. 2020 Apr;40(4):841-847.
7.Khuthaila MK, Hsu J, Chiang A, DeCroos FC, Milder EA, Setlur V, et al. Postoperative vitreous hemorrhage after diabetic 23-gauge pars plana vitrectomy. Am J Ophthalmol. 2013 Apr;155(4):757-63, 763.e1-2.
8.Sato T, Morita S, Bando H. Early vitreous hemorrhage after vitrectomy with preoperative intravitreal bevacizumab for proliferative diabetic retinopathy. Middle East Afr J Ophthalmol. Jan-Mar 2013;20(1):51-5.
9.Tsubota K, Usui Y, Wakabayashi Y, Suzuki J, Ueda S, Goto H. Effectiveness of prophylactic intravitreal bevacizumab injection to proliferative diabetic retinopathy patients with elevated preoperative intraocular VEGF in preventing complications after vitrectomy. Clin Ophthalmol. 2019 Jun 28;13:1063-1070.
10.Yang CM, Yeh PT, Yang CH, Chen MS. Bevacizumab pretreatment and long-acting gas infusion on vitreous clear-up after diabetic vitrectomy. Am J Ophthalmol. 2008 Aug;146(2):211-217.
11.Nosov SV. [Tactics of treatment for late post-vitrectomy vitreous hemorrhage in patients with diabetes mellitus]. Oftalmokhirurgiia. 2011;3:53-6. Russian.
12.Putienko AA, Elhaj Ali, Pogorelyi DN. [Results of treatment of post-vitrectomy vitreous hemorrhage in patients with proliferative diabetic retinopathy]. Oftalmol Zh. 2015;2:22-6. Russian.
13.Koutsandrea CN, Apostolopoulos MN, Chatzoulis DZ, et al. Hemostatic effects of SF6 after diabetic vitrectomy for vitreous hemorrhage. Acta Ophthalmol Scand. 2001 Feb;79(1):34-8.
14.Putienko AA, Pogorelyi DN. [cytokine profile of blood and vitreous fluid in proliferative diabetic retinopathy patients with vitreous hemorrhage after vitrectomy]. Kazanskii meditsinskii zhurnal. 2013;94(1):26-30. Russian.
15.Mahalingam P, Topiwalla TT, Ganesan G. Vitreous rebleed following sutureless vitrectomy: incidence and risk factors. Indian J Ophthalmol. 2018 Apr;66(4):558-561.