Intravitreal injection of bevacizumab and triamcinolone acetonide at the end of vitrectomy for diabetic vitreous hemorrhage: A comparative study

Background: To study the clinical outcome and complications of intravitreal bevacizumab (IVB) versus triamcinolone acetonide (IVT) injections at the end of vitrectomy in patients with diabetic vitreous hemorrhage. Methods: This is a retrospective comparative case study comprised of 156 eyes from 139 consecutive patients who underwent pars plana vitrectomy for diabetic vitreous hemorrhage (VH) with or without tractional retinal detachment (TRD). IVB (1.25 mg/0.05 ml) injection was done for 66 eyes (60 patients) and IVT (4 mg/0.1 ml) injection for 33 eyes (31 patients) at the end of vitrectomy, and no injection was done for 57 eyes (48 patients). Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), and incidence of postoperative VH and reoperation with at least 12 months of follow-up. Results: Early postoperative VH within 1 month postoperatively occurred in eight eyes (12.1%) from the IVB group, three eyes (9.1%) from the IVT group, and 21 eyes (36.8%) from the control group. The rate of early postoperative VH was significantly lower in the IVB and IVT group than the control group (p=0.002 and 0.006, respectively). Late postoperative VH after 1 month postoperatively occurred in 11 eyes (16.7%) from the IVB group, three eyes (9.1%) from the IVT group, and 12 eyes (21.1%) from the control group. There was no difference between the three groups (P=0.341). BCVA of the IVB, IVT, and control group at postoperative months 1, 3, 6, 9, and 12 significantly improved from the preoperative BCVA (p<0.01, respectively). There was no difference for BCVA between the three groups at each follow-up period (p>0.05). In only the IVT group, IOP at postoperative day 1 was higher than IOP preoperatively (p=0.002). There was no significant difference in the rate of reoperation between the three groups (p=0.275). Conclusion: IVB and IVT injection at the end of diabetic vitrectomy is a useful adjunctive therapy for reducing early postoperative VH compared to the control group. IVB injection does not have a risk of a temporary rise of IOP, which the IVT group has.