Grand Round

PRESENTER:DR PARUL GOYAL

CHAIRPERSON:DR MANSI SHARMA
 58 yrs M DOP 17-12-12
Chief complaints
 Painless progressive diminution of vision B/E since 1 year worsening more
over past 1 month
 No h/o any ocular trauma/surgery/use of any medication
 No h/o flashes of light
 He was treated elsewhere where B/E Panretinal laser photocoagulation was
done .
 k/c/o DM * 20 yrs on injection Insulin
 k/c/o HTN *1 yr on irregular medication
 no other systemic illness
 O/E
OD OS

BCVA 6/60 CF 3m

IOP(GAT) 15mm Hg 15mm Hg

Lid and adnexa WNL WNL

A/S No NVI No NVI

No RAPD No RAPD
NS2 NS2
P/S Photo photo
OD
OS
 Clinical Diagnosis

 R/E Proliferative Diabetic Retinopathy S/P PRP

 L/E Proliferative Diabetic Retinopathy S/P PRP with Tractional Retinal
Detachment
OD
OS
 Systemic Investigations

 Hb-9gm
 Hb A1C-8.2%
 FBS -197 mg/dl
 PPBS-253mg/dl
 Cholesterol-145mg/dl
 TG-92mg/dl
 LDL-89mg/dl
 HDL-39mg/dl
 24 hrs urinary protein-247mg
FFA (OD)
OS
 Management Plan

 Systemic control of diabetes mellitus

 Advised B/E supplemental Pan Retinal Photocoagulation
 Planned for L/E PPV after endocrinology clearence
 R/E supplemental PRP done on 21/12/12
 L/E supplemental PRP done on 24/12/12
20/3/2013 OD

Va 1/60
IOP 20mmHg (NCT)
20/3/2012 OS

Va CF 2m
IOP 18mmHg
 Surgery

 L/E pre op IVT avastin given on 26/3/13

 L/E PPV(23G)+EL+FGE+SF6(20%) done on 2/4/2013
Post op (OS)

Va 6/36+1
IOP 17 mmHg
OS
10/07/2013 OD

Va CF 3m
IOP 16mm Hg
 Planed for R/E PPV after Inj Avastin
 R/E IVT avastin given on 23/7/13
 R/E PPV+FVP dissection+EL+FAE+SF6 done on 30/7/13
Post op

Va 6/60
IOP 18mm Hg
OD
 Last Follow Up (16/7/2014)
OD OS

Va 6/60 Va 6/36+1
IOP 16mmHg IOP 18mm Hg
 Role of Bevacizumab pretreatment in diabetic vitrectomy

 It takes variable time for PRP to cause neovascular regression and places the patient
with PDR at risk for vitreous hemorrhage and tractional retinal detachment

 Avastin (Humanized monoclonal antibody to all isoforms of VEGF) induces rapid

regression of retinal neovascularization

 Reduces intraoperative bleeding making surgery easier and faster

 Reduces the occurrence of residual blood clots

 Reduces vitreous clear up time

 Reduces the chances of early post-op vitreous hemorrhage

Am J Ophthalmol 2008;146:211–217
Thank You