Efficacy of Simultaneous Usage of Bevacizumab and Silicone Oil Injection After Vitrectomy in Diabetic Tractional Retinal Detachment


1 Assistant Professor of Ophthalmology, Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Department of Ophthalmology, Bina Eye Hospital Research Center, Tehran, Iran

3 Associate Professor of Ophthalmology, Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran

4 Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran


Abstract Background: Tractional retinal detachment (TRD), a major vision threatening complication, is one of the most common eye emergencies. The most common cause of TRD is proliferative diabetic retinopathy (PDR). The aim of this study was to evaluate the effect of simultaneous usage of bevacizumab and silicone oil injection after vitrectomy for the treatment of diabetic tractional retinal detachment Methods: Twenty five patients (25 eyes) with severe proliferative diabetic retinopathy were recruited into the study. All eyes underwent a single intravitreal injection of bevacizumab 1.25 mg in 0.05 mL along with silicone oil injection after vitrectomy for the management of tractional retinal detachment or vitreous hemorrhage due to severe proliferative diabetic retinopathy. Patients were then scheduled for postoperative clinical examinations at one, three and six months. The main outcome measures were regression of neovascularization, intraocular pressure, visual acuity and retinal reattachment. Results: This study evaluated 25 eyes of 25 patients (12 men, 13 women) with a mean age of 55.686.94 years (range 21 to 49 years). In all eyes visual acuity improved and retinal attachment was accomplished. The mean preoperative visual acuity was 2.01  0.03 Log MAR which significantly improved to 1.10  0.50 Log MAR in 6th month after surgery (P < 0.000). Active neovascularization regressed significantly (P < 0.004) and intraocular pressure was controlled in 88% of patients. Conclusions: The findings of our study may suggest that simultaneous injection of Bevacizumab and silicone oil after vitrectomy improve early results. We have found it to be particularly useful in diabetic eyes with tractional detachments of short duration.


  1. 1.Ferrara N. Vascular endothelial growth factor: basic science and clinical progress. Endocr Rev. 2004;25(4):581–611. doi: 10.1210/er.2003-0027. [PubMed: 15294883].

    1. Thompson JT, de Bustros S, Michels RG, Rice TA. Results and prognostic factors in vitrectomy for diabetic traction retinal detachment of the macula. Arch Ophthalmol. 1987;105(4):497–502. doi: 10.1001/archopht.1987.01060040073036. [PubMed: 2436603].
    2. Tolentino FI, Cajita VN, Gancayco T, Skates S. Vitreous hemorrhage after closed vitrectomy for proliferative diabetic retinopathy. Ophthalmology. 1989;96(10):1495–500. doi: 10.1016/S0161-6420(89)32700- X. [PubMed: 2587044].
    3. Schachat AP, Oyakawa RT, Michels RG, Rice TA. Complications of vitreous surgery for diabetic retinopathy. Ophthalmology. 1983;90(5):522– 30. doi: 10.1016/s0161-6420(83)34540-1.
    4. Novak MA, Rice TA, Michels RG, Auer C. Vitreous hemorrhage after vitrectomy for diabetic retinopathy. Ophthalmology. 1984;91(12):1485–9. doi: 10.1016/S0161-6420(84)34099-4. [PubMed: 6521989].
    5. Blankenship GW. Management of vitreous cavity hemorrhage following pars plana vitrectomy for diabetic retinopathy. Ophthalmology. 1986;93(1):39–44. doi: 10.1016/S0161-6420(86)33791-6. [PubMed: 2419815].
    6. Chen E, Park CH. Use of intravitreal bevacizumab as a preoperative adjunct for tractional retinal detachment repair in severe proliferative diabetic retinopathy. Retina. 2006;26(6):699–700. doi: 10.1097/01.iae.0000225351.87205.69. [PubMed: 16829817].
    7. Khafagy A. Role of adjunctive use of intravitreal bevacizumab for severe proliferative diabetic retinopathy before vitrectomy. Med J Cairo Univ. 2011;79(2).
    8. Ghasemi Falavarjani K, Hashemi M, Modarres M, Hadavand Khani A. Intrasilicone oil injection of bevacizumab at the end of retinal reattachment surgery for severe proliferative vitreoretinopathy. Eye (Lond). 2014;28(5):576–80. doi: 10.1038/eye.2014.21. [PubMed: 24556886].
    9. Yeh PT, Yang CH, Yang CM. Intravitreal bevacizumab injection for recurrent vitreous haemorrhage after diabetic vitrectomy.Acta Ophthalmol. 2011;89(7):634–40. doi: 10.1111/j.1755-3768.2009.01821.x. [PubMed: 20064118].
    10. Ishikawa K, Honda S, Tsukahara Y, Negi A. Preferable use of intravitreal bevacizumab as a pretreatment of vitrectomy for severe proliferative diabetic retinopathy. Eye (Lond). 2009;23(1):108–11. doi: 10.1038/sj.eye.6702983. [PubMed: 17891057].
    11. Abu El-Asrar AM, Al-Bishi SM, Kangave D. Outcome of temporary silicone oil tamponade in complex rhegmatogenous retinal detachment. Eur J Ophthalmol. 2003;13(5):474–81. [PubMed: 12841571].
    12. Ghazi NG, Green WR. Pathology and pathogenesis of retinal detachment. Eye (Lond). 2002;16(4):411–21. doi: 10.1038/sj.eye.6700197. [PubMed: 12101448].
    13. Xu Y, You Y, Du W, Zhao C, Li J, Mao J, et al. Ocular pharmacokinetics of bevacizumab in vitrectomized eyes with silicone oil tamponade. Invest Ophthalmol Vis Sci. 2012;53(9):5221–6. doi: 10.1167/iovs.12-9702. [PubMed: 22786911].
    14. Sivak-Callcott JA, O’Day DM, Gass JD, Tsai JC. Evidence-based recommendations for the diagnosis and treatment of neovascular glaucoma. Ophthalmology. 2001;108(10):1767–76. doi: 10.1016/S0161- 6420(01)00775-8. [PubMed: 11581047] quiz1777, 1800.
    15. Wakabayashi T, Oshima Y, Sakaguchi H, Ikuno Y, Miki A, Gomi F, et al. Intravitreal bevacizumab to treat iris neovascularization and neovascular glaucoma secondary to ischemic retinal diseases in 41 consecutive cases. Ophthalmology. 2008;115(9):1571–80. doi: 10.1016/j.ophtha.2008.02.026. [PubMed: 18440643] 1580 e1-3.
    16. Oshima Y, Sakaguchi H, Gomi F, Tano Y. Regression of iris neovascularization after intravitreal injection of bevacizumab in patients with proliferative diabetic retinopathy. Am J Ophthalmol. 2006;142(1):155–8. doi: 10.1016/j.ajo.2006.02.015. [PubMed: 16815267].
    17. Ahmadieh H, Shoeibi N, Entezari M, Monshizadeh R. Intravitreal bevacizumab for prevention of early postvitrectomy hemorrhage in diabetic patients: a randomized clinical trial. Ophthalmology. 2009;116(10):1943–8. doi: 10.1016/j.ophtha.2009.07.001. [PubMed: 19699531].
    18. Lo WR, Kim SJ, Aaberg TM Sr, Bergstrom C, Srivastava SK, Yan J, et al. Visual outcomes and incidence of recurrent vitreous hemorrhage after vitrectomy in diabetic eyes pretreated with bevacizumab (avastin). Retina. 2009;29(7):926–31. doi: 10.1097/IAE.0b013e3181a8eb88. [PubMed: 19584650].
    19. Yeh PT, Yang CM, Lin YC, Chen MS, Yang CH. Bevacizumab pretreatment in vitrectomy with silicone oil for severe diabetic retinopathy. Retina. 2009;29(6):768–74. doi: 10.1097/IAE.0b013e3181a3b7ef. [PubMed: 19516117].
    20. Sawada O, Kawamura H, Kakinoki M, Sawada T, Ohji M. Vascular endothelial growth factor in aqueous humor before and after intravitreal injection of bevacizumab in eyes with diabetic retinopathy. Arch Ophthalmol. 2007;125(10):1363–6. doi: 10.1001/archopht.125.10.1363. [PubMed: 17923544]. 4 Razavi Int J Med. 2017; 5(2):e43217. Alishiri A et al.
    21. Arevalo JF, Maia M, Flynn HW Jr, Saravia M, Avery RL, Wu L, et al. Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy. Br J Ophthalmol. 2008;92(2):213–6. doi: 10.1136/bjo.2007.127142. [PubMed: 17965108].
    22. Jampol LM, Shankle J, Schroeder R, Tornambe P, Spaide RF, Hee MR. Diagnostic and therapeutic challenges. Retina. 2006;26(9):1072–6. doi: 10.1097/01.iae.0000248819.86737.a5. [PubMed: 17151497].
    23. Jorge R, Costa RA, Calucci D, Cintra LP, Scott IU. Intravitreal bevacizumab (Avastin) for persistent new vessels in diabetic retinopathy (IBEPE study). Retina. 2006;26(9):1006–13. doi: 10.1097/01.iae.0000246884.76018.63. [PubMed: 17151487].
    24. Avery RL, Pearlman J, Pieramici DJ, Rabena MD, Castellarin AA, Nasir MA, et al. Intravitreal bevacizumab (Avastin) in the treatment of proliferative diabetic retinopathy. Ophthalmology. 2006;113(10):1695 e1– 15. doi: 10.1016/j.ophtha.2006.05.064. [PubMed: 17011951].