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Intravitreal bevacizumab versus intravitreal triamcinolone in the prevention of intraoperative bleeding in diabetic vitrectomy; a randomized clinical trial

Behzad Safarpour Lima, Shima Sayanjali, Morteza Entezari, Homayoun Nikkhah, Ali Rastegarpour, Mehdi Yaseri, Alireza Asary Yazdi, Hamid Fateh Moghaddam, Alireza Ramezani.


Diabetic retinopathy is a diabetes complication that affects eyes. It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye. So, the aim of this study was to compare the effects of intravitreal injection of TA and bevacizumabon intraoperative bleeding in eyes candidate for diabetic vitrectomy. Consecutive patients undergoing primary pars plana vitrectomy for complications of active PDR were recruited for this prospective study. The indications for vitrectomy included non-clearing vitreous hemorrhage, tractional retinal detachment, or active fibrovascular proliferation with or without TRD. Patients undergoing vitrectomy due to diabetic macular edema were not included. Patients were divided into two groups using a randomizing table; the first group received an intravitreal injection of bevacizumab 1.25 mg, and the second group received an intravitreal injection of triamcinolone 2 mg before surgery. After the operations, the attending surgeon completed a study questionnaire. All statistical analyses were performed by SPSS version 21. The P-value less than 0.05 was considered statistically significant. In this study, 141 eyes of 141 diabetic patients with an average age of 54 ± 10 were included. Of them, 74 and 67 were allocated to the IVB and IVT groups, respectively. There was no statistical difference between the groups regarding demographic and preoperative characteristics. We also did not notice any difference in the intraoperative data between the groups except for the uses of PFCL and internal tamponade that were significantly higher in the IVB group. Intraoperative bleeding occurs in 53 (71.6%) and 46 (68.7%) of the eyes in the IVB and IVT groups, respectively. The ATE based on the results of the AIPW model for the two groups in terms of intraoperative bleeding was 1.3% which failed to show a statistically significant difference. Our study demonstrated that preoperative IVT injection could at least be as effective as preoperative IVB injection as far as intraoperative bleeding in diabetic vitrectomy is concerned.

Key words: Intravitreal bevacizumab, intravitreal triamcinolone, intraoperative bleeding, diabetic vitrectomy.

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