The effect of bevacizumab before vitrectomy for diabetic tractional retinal detachment demonstrated on optical coherence tomography angiography

Purpose: To demonstrate the effect of intravitreal bevacizumab (IVB) on the size and vascularity of the fibro-vascular complex with the optical coherence tomography angiography (OCTA) before pars plana vitrectomy (PPV). Methods: Observational case series of three eyes with active diabetic fibro-vascular complex and tractional retinal detachment (TRD) who underwent IVB (1.25 mg/0.05 ml) two days before proceeding to PPV. OCTA was carried out prior to IVB, two days after IVB and six weeks after PPV. Results: OCTA showed a reduction in the size and calibre of the diabetic fibro-vascular complex two days after IVB in all the cases. Consequently, there was less traumatic dissection of the fibro-vascular membranes during PPV and thus reduced chances of intraoperative and postoperative vitreous cavity bleeding. One case showed mild hemorrhage in the posterior vitreous on the second day post-injection which implies the increased traction caused by IVB. Conclusions: In this case series, we have used OCTA to demonstrate how IVB is highly effective in reducing the vascularity of diabetic fibrovascular membranes. This finding also suggests that the use of IVB before PPV in the nagement of diabetic TRD could also be much shorter than the advocated standard practice of one week in most institutions.