Department of Ophthalmology, Kangwon National University Hospital, Chuncheon, South Korea.
SMG-SNU Boramae Medical Center, Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.
Eye (Lond). 2021 Nov;35(11):3056-3063. doi: 10.1038/s41433-020-01384-y. Epub 2021 Jan 8.
To investigate the efficacy of intravitreal bevacizumab injections (IVBs) for vitreous haemorrhage (VH) in proliferative diabetic retinopathy (PDR) with prior complete panretinal photocoagulation (PRP).
A multicentre cohort study of eyes with new VH in PDR after documented previous complete PRP was performed. Eyes were grouped according to IVB treatment at baseline, and cumulative rate of vitrectomy and spontaneous clear-up rate were compared as the main outcome. Eyes requiring vitrectomy within 1 month, or with tractional retinal detachment (TRD), or with spontaneous clear-up within 1 month, were excluded.
In total, 44 eyes with IVB and 92 control eyes without IVB were followed up to 20.1 months. Cumulative probability of vitrectomy was lower in the IVB group at 12 months (0.16 vs 0.42, IVB vs controls), and throughout the follow-up period (p = 0.005). Cumulative probability of spontaneous clear-up was higher in the IVB group at 12 months (0.81 vs 0.68, IVB vs controls), and throughout the follow-up period (p = 0.013). Best-corrected visual acuity (BCVA) at 1 month after onset of VH was significantly better in the IVB group (0.513 vs 0.942 logarithm of the minimal angle of resolution, p = 0.002); however, the difference of BCVA lost significance with further follow-up. IVB treatment was the only factor significantly associated with vitrectomy risk on multivariate analysis (p = 0.047, hazard ratio 0.506).
In VH after prior complete PRP, IVB was effective in decreasing vitrectomy requirement, although overall visual benefit was short-term. IVB can be considered to defer vitrectomy in PDR VH eyes with prior complete PRP and no TRD.
研究在既往全视网膜光凝（PRP）后发生增生性糖尿病性视网膜病变（PDR）伴玻璃体积血（VH）患者中玻璃体内注射贝伐单抗（IVB）的疗效。
对既往有明确 PRP 治疗史的 PDR 患者新发生 VH 进行多中心队列研究。根据基线时是否行 IVB 治疗将眼分为两组，主要观察指标为玻璃体切割术累积率和自发吸收率。排除 1 个月内行玻璃体切割术或发生牵拉性视网膜脱离（TRD）或 1 个月内自发吸收的眼。
共纳入 44 例接受 IVB 治疗的眼和 92 例未行 IVB 治疗的对照眼，随访时间为 20.1 个月。12 个月时 IVB 组玻璃体切割术累积概率较低（0.16 比 0.42，IVB 组比对照组），且在整个随访期间（p=0.005）均如此。12 个月时 IVB 组自发吸收概率较高（0.81 比 0.68，IVB 组比对照组），且在整个随访期间均如此（p=0.013）。VH 发生后 1 个月最佳矫正视力（BCVA）在 IVB 组明显更好（0.513 比 0.942，最小分辨角对数，p=0.002）；然而，随着进一步随访，BCVA 丢失的差异无统计学意义。多变量分析显示 IVB 治疗是玻璃体切割术风险的唯一显著相关因素（p=0.047，风险比 0.506）。
在既往全视网膜光凝后发生 VH 的患者中，IVB 可有效降低玻璃体切割术的需求，尽管总体视力获益是短期的。对于既往行全视网膜光凝且无 TRD 的 PDR VH 眼，IVB 可考虑延迟玻璃体切割术。
