Therapeutic effect and safety of 23G pars plana vitrectomy assisted by ranibizumab for severe proliferative diabetic retinopathy

Authors: Xie Zhenggao,  Chen Fang,  Zhu Jun,  Du Wei,  Chen Xi,  Gan Chunlan
DOI: 10.3760/cma.j.issn.2095-0160.2015.12.013
Published 2015-12-10
Cite as Chin J Exp Ophthalmol, 2015,33(12): 1113-1117.

Abstract                              [Download PDF] [Read Full Text]

Background

Pars plana vitrectomy (PPV) is a main method of treating severe proliferative diabetic retinopathy (PDR), but intraoperative bleeding often occurs, which affects the intraoperative process and final prognosis.Intravitreal injection of ranibizumab (IVR), a vascular endothelial growth factor (VEGF) monoclonal antibody, has been used in PPV, so the evaluation of therapeutic effect and safety of PPV associated by IVR is very important.

Objective

This study was to evaluate the effect of IVR-assisted 23G PPV on patients with severe PDR.

Methods

The clinical data of 82 eyes of 77 patients with severe PDR who received 23G PPV from August 2012 to December 2013 were respectively analyzed, including 49 eyes undergone IVR-assisted 23G PPV (IVR combined with PPV group) and 33 eyes undergone 23G PPV only (simple PPV group). IVR (0.5 mg/0.05 ml) was performed on the eyes 5-7 days before PPV in the IVR combined with PPV group, and only PPV was carried out in the simple PPV group.Operative duration, endodiathermy times, incidence of iatrogenic retinal holes, best corrected visual acuity (BCVA)(LogMAR), postoperative bleeding, re-operation rate, Ⅰphase attached rate of retinas, occurrence rate of neovascular glaucoma and temporary ocular hypertension rate were compared between the two groups.

Results

The average operation duration was (71.90±26.42) minutes in the IVR combined with PPV group, which was significantly shorter than (96.76±25.15) minutes in the simple PPV group (t=-4.300, P<0.05). Endodiathermy time in the IVR combined with PPV group was significantly less than that in the simple PPV group (0.76±0.14 versus 2.18±1.64) (χ2=-4.284, P<0.01). The BCVA at postoperative 3 months was (0.70±0.50) and (0.74±0.50) in the IVR combined with PPV group and simple PPV group, which was significantly improved in comparison with before operation (1.73±0.50, 1.70±0.470) respectively (t=-0.151, 0.118, both at P<0.01), but no significant difference in the postoperative BCVA between the two groups (t=-0.318, P=0.758). The incidence of iatrogenic retinal holes was significantly lower in the IVR combined with PPV group than that in the simple PPV group (6.12% versus 21.20%) (χ2=4.193, P=0.041). In addition, the postoperative bleeding rate was also significantly different between the IVR combined with PPV group and the simple PPV group (2.04% versus 15.15%) (χ2=6.580, P=0.010). No significant differences were seen in the incidence of re-operation rate, Ⅰphase attached rate of retinas, occurrence rate of neovascular glaucoma and temporary ocular hypertension rate between two groups (all at P>0.05).

Conclusions

IVR before 23G PPV can reduce the risk of intravitreal bleeding during operation and after surgery, shorten operation duration and lessen the incidence of iatrogenic retinal break.The BCVA after IVR-assisted PPV improves as good as simple PPV.

Key words:

Antibodies, monoclonal, humanized/administration; Intravitreal injection; Diabetic retinopathy/surgery; Vitrectomy; Treatment outcome; Postoperative complications; Retrospective studies; Ranibizumab

Contributor Information

Xie Zhenggao
Department of Ophthalmology, Clinical Medicine School of Yangzhou University, Yangzhou 225001, China
Chen Fang
Zhu Jun
Du Wei
Chen Xi
Gan Chunlan
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Updated: February 27, 2023 — 7:19 am