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2017, Number 1

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Rev Med MD 2017; 8.9 (1)

Antiangiogenic therapy in diabetic post-vitrectomy patients

Ontiveros-Pérez DO, Jacinto-Buenrostro JE, Cortes-Quezada S, Mendoza-Adam G, Cisneros-Gómez SM, Arévalo-Simental D, Roig-Melo EA

Language: Spanish
References: 17
Page: 18-24
PDF size: 606.28 Kb.


ABSTRACT

Introduction. Vitrectomy has been the mainstay of surgical treatment for the complications of advanced proliferative diabetic retinopathy (PDR). Since its inception, efforts have been madeto optimize the anatomical and visual results of these patients; however, they have been limited by the high rate of post-surgical complications related to proliferative activity and vascular permeability. Prospects are now focused on antiangiogenic therapy before or during surgery. However, little has been studied about its post-vitrectomy use. The present study aims to know the frequency and risk factors related to the postoperative application of antiangiogenic therapy in patients with advanced diabetic retinopathy undergoing pars plana vitrectomy.
Material and Methods. We performed a retrospective analysis of patients with advanced diabetic retinopathy who underwent PPV between March 2014 and March 2015, from Fray Antonio Alcalde Civil Hospitalin Guadalajara, Jalisco. We obtain the percentage of patients to whom antiangiogenic therapy was used after vitrectomy. Their characteristics and efficacy were analyzed by subgroups. Efficacy was measured as the percentage of treated patients in whom surgical reoperation was avoided. Descriptive statistics and crosstabs analysis were made to obtain odds ratio (OR) analysis.
Results. We included 103 patients with an average follow-up of 10.27 months. Intravitreal antiangiogenic therapy was used in 28 patients (27.18%). The main indications were the development of neovascular glaucoma, postoperative vitreous hemorrhage and diabetic macular edema in 13.59%, 9.7% and 4.8%, respectively. The average time between surgery and the application was 3.6 months and 1.5 injections with important variations according to their indication. The application of intravitreal antiangiogenic before surgery was identified as a risk factor (OR 12.33, 95% CI, 1.31 - 115.75). In 60% of the treated cases the surgical reintervention was avoided.
Discussion. The use of antiangiogenic therapy in the vitrectomized diabetic patient is quite common (27.18%), being the necessity of its prior use to vitrectomy is the main risk factor.


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