From the Guidelines
Administering an additional intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection closer to the time of vitrectomy surgery for intravitreal hemorrhage due to proliferative diabetic retinopathy (PDR) is recommended if the last injection was six weeks prior to surgery, as it may reduce the duration of surgery, the number of retinal breaks, and the amount of intra-operative bleeding. When considering the management of PDR, particularly in the context of vitrectomy surgery for intravitreal hemorrhage, the timing of anti-VEGF injections is crucial 1. The evidence suggests that pre-operative anti-VEGF treatment can lead to improved surgical outcomes 1. Key benefits include:
- Reduced duration of surgery
- Decreased number of retinal breaks
- Less intra-operative bleeding Given that the last injection was six weeks prior to surgery, an additional injection might be beneficial, especially if there are signs of active PDR. The ideal timing for these injections is 3-7 days before surgery to maximize their effect 1. It is essential to consider the individual patient's situation, including the severity of PDR, the extent of the hemorrhage, and their response to previous injections. The decision should be made in consultation with a retinal specialist, weighing the potential benefits against any risks associated with an additional injection or possible surgical delays 1.
From the Research
Administration of Additional Intravitreal Anti-VEGF Injection
- The decision to administer an additional intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection closer to the time of vitrectomy surgery for intravitreal hemorrhage due to proliferative diabetic retinopathy (PDR) if the last injection was six weeks prior to surgery can be informed by several studies 2, 3, 4, 5, 6.
- A systematic review and meta-analysis found that preoperative anti-VEGF treatment can facilitate easier surgical procedures and reduce intra- and postoperative complications in patients with PDR 2.
- Another study identified younger age and presence of neovascular glaucoma and tractional retinal detachment as potential biases in using preoperative intravitreal anti-VEGF injection for PDR complications 3.
- The combined use of anti-VEGF drugs before and during pars plana vitrectomy has been shown to have more significant prognostic benefits and favorable safety profiles in patients with severe PDR 4.
- The role of anti-VEGF in the management of PDR has been established, with drugs targeting VEGF being effective in reducing vascular proliferation and improving visual outcomes 5.
- A study on the dose of intravitreal bevacizumab used as preoperative adjunct therapy for PDR found that lower doses can be effective in reducing vitreous VEGF concentrations and intraoperative bleeding 6.
Considerations for Administration
- The optimal interval and dosage for preoperative anti-VEGF injection are still being evaluated and may depend on individual patient factors 2, 6.
- The benefits of preoperative anti-VEGF treatment must be weighed against potential risks and limitations, including the need for careful patient selection and monitoring 5.
- Further studies are needed to verify the findings and establish clear guidelines for the use of preoperative anti-VEGF injections in patients with PDR 2, 4.