Microincision vitrectomy surgery and intravitreal injection of ranibizumab to treat severe proliferative diabetic retinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

WangDegong ,  ChenSong , WangYun , 林莉 , 宫丽 , 段红涛

Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Hospital, Tianjin Institute of Ophthalmology, Tianjin 300020, China;

Corresponding author：

ChenSong, Email: chensong20@hotmail.com

Keywords：

Diabetic retinopathy/ surgery; Vitrectomy; Diabetic retinopathy/drug therapy; Antibodies, monoclonal/therapeutic use

DOI：

10.3760/cma.j.issn.1005-1015.2014.02.005

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Objective To observe the clinical effect of microincision vitreoretinal surgery (VRS) assisted with intravitreal injection of ranibizumab (IVR) in severe proliferative diabetic retinopathy (PDR) treatment. Methods This is a prospective non-randomized controlled clinical study. A total of 60 patients (70 eyes) with severe PDR diagnosed were enrolled and divided into IVR group (31 patients, 35 eyes) and control group (29 patients, 35 eyes). IVR group patients received an intravitreal injection of 0.05 ml ranibizumab solution (10 mg/ml) first, and 3 or 4 days later they received 23G microincision VRS. Control group patients only received 23G microincision VRS. The follow-up time was 3 to 12 months with an average of (4.5±1.8) months. The logarithm of the minimal angle of resolution (logMAR) best corrected visual acuity (BCVA), intraocular pressure, the central retinal thickness (CRT) and retinal reattachment, and the incidence of postoperative complications were comparatively analyzed. Results There was no topical and systemic adverse reactions associated with the drug after injection in IVR group. The incidence of post-operative vitreous hemorrhage (VH) in IVR group and control group was 8.6% and 28.6% at 1 week after surgery, 0.0% and 17.1% at 1 month after surgery, 0.0% and 8.6% at 3 month after surgery respectively. The differences were statistically significant for 1 week (χ²=4.63, P < 0.05) and 1 month (χ²=4.56, P < 0.05), but was not statistically significant for 3 months (χ²=0.24, P > 0.05). The mean post-operative logMAR BCVA of IVR group (0.81±0.40) and control group (1.05±0.42) have all improved than their pre-operative BCVA, the difference was statistically significant (t=12.78, 4.39; P < 0.05). The mean logMAR BCVA of IVR group is higher than BCVA of control group, the difference was statistically significant (t=-2.36, P < 0.05). The average post-operative CRT in IVR group was thinner than that of control group, the difference was statistically significant (t=-2.53, P < 0.05). The incidence of a transient high intraocular pressure in IVR group (14.3%) was lower than that in control group (34.3%), the difference was statistically significant (t=4.79, P < 0.05). The incidence of retinal reattachment (t=0.35), epiretinal membrane (χ²=0.97), neovascular glaucoma (χ²=0.51) was no difference between these two groups (P > 0.05). Conclusion The minimally invasive VRS assisted by IVR treatment for severe PDR can effectively prevent postoperative VH, reduce CRT and improve visual acuity.

Citation： WangDegong, ChenSong, WangYun. Microincision vitrectomy surgery and intravitreal injection of ranibizumab to treat severe proliferative diabetic retinopathy. Chinese Journal of Ocular Fundus Diseases, 2014, 30(2): 136-140. doi: 10.3760/cma.j.issn.1005-1015.2014.02.005 Copy

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2.	CATT Research Group, Martin DF, Maguire MG, et al. Ranibizumab and bevacizumab for neovascular age-related macular degeneration:two-year results[J]. Ophthalmology, 2012, 119:1388-1398.
3.	El-Sabagh HA, Abdelghaffar W, Labib AM, et al. Preoperative intravitreal bevacizumab use as an adjuvant to diabetic vitrectomy:histopathologic findings and clinical implications[J]. Ophthalmology, 2011, 118:636-641.
4.	中华医学会眼科学分会眼底病学组.糖尿病视网膜病变分期标准[J].眼底病, 1985, 1:42.
5.	Modarres M, Nazari H, Falavarjeni KG, et al.Intravitreal injection of bevacizumab before vitrectomy for proliferative diabetic retinopathy[J].Eur J Ophthalmol, 2009, 19:848-852.
6.	Ishikawa K, Honda S, Tsukahara Y, et al.Preferable use of intravitreal bevacizumab as a pretreatment of vitmetomy for severe proliferative diabetic retinopathy[J].Eye, 2009, 23:108-111.
7.	Ahmadieh H, Shoeibi N, Entezari M, et al.Intravitreal bevacizumab for prevention of early postvitrectomy hemorrhage in diabetic patients:a randomized clinical trial[J]. Ophthalmology, 2009, 116:1943-1948.
8.	Ahn J, Woo SJ, Chung H, et al. The effect of adjunctive intravitreal bevacizumab for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy[J]. Ophthalmology, 2011, 118:2218-2226.
9.	Nguyen QD, Tatlipinar S, Shah SM, et al. Vascular endothelial growth factor is a critical stimulus for diabetic macular edema[J]. Am J Ophthalmol, 2006, 142:961-969.
10.	Willerslev A, Munch IC, Larsen M. Resolution of diabetic papillopathy after a single intravitreal injection of ranibizumab[J]. Acta Ophthalmol, 2012, 90:407-409.
11.	Gupta A, Bansal R, Gupta V, et al. Six-month visual outcome after pars plana vitrectomy in proliferative diabetic retinopathy with or without a single preoperative injection of intravitreal bevacizumab[J].Int Ophthalmol, 2012, 32:135-144.
12.	Yeh PT, Yang CM, Lin YC, et al.Bevacizumab pretreatment in vitrectomy with silicone oil for severe diabetic retinopathy[J].Retina, 2009, 29:768-774.
13.	Farahvash MS, Majidi AR, Roohipoor R, et al.Preoperative injection of intravitreal bevacizumab in dense diabetic vitreous hemorrhage[J]. Retina, 2011, 31:1254-1260.

1. Hershberger VS, Augsburger JJ, Hutchins RK, et al. Fibrovascular in growth at sclerotomy sites in vitrectomized diabetic eyes with recurrent vitreous hemorrhage:ultrasound biomicroscopy findings[J].Ophthalmology, 2004, 111:1215-1221.
2. CATT Research Group, Martin DF, Maguire MG, et al. Ranibizumab and bevacizumab for neovascular age-related macular degeneration:two-year results[J]. Ophthalmology, 2012, 119:1388-1398.
3. El-Sabagh HA, Abdelghaffar W, Labib AM, et al. Preoperative intravitreal bevacizumab use as an adjuvant to diabetic vitrectomy:histopathologic findings and clinical implications[J]. Ophthalmology, 2011, 118:636-641.
4. 中华医学会眼科学分会眼底病学组.糖尿病视网膜病变分期标准[J].眼底病, 1985, 1:42.
5. Modarres M, Nazari H, Falavarjeni KG, et al.Intravitreal injection of bevacizumab before vitrectomy for proliferative diabetic retinopathy[J].Eur J Ophthalmol, 2009, 19:848-852.
6. Ishikawa K, Honda S, Tsukahara Y, et al.Preferable use of intravitreal bevacizumab as a pretreatment of vitmetomy for severe proliferative diabetic retinopathy[J].Eye, 2009, 23:108-111.
7. Ahmadieh H, Shoeibi N, Entezari M, et al.Intravitreal bevacizumab for prevention of early postvitrectomy hemorrhage in diabetic patients:a randomized clinical trial[J]. Ophthalmology, 2009, 116:1943-1948.
8. Ahn J, Woo SJ, Chung H, et al. The effect of adjunctive intravitreal bevacizumab for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy[J]. Ophthalmology, 2011, 118:2218-2226.
9. Nguyen QD, Tatlipinar S, Shah SM, et al. Vascular endothelial growth factor is a critical stimulus for diabetic macular edema[J]. Am J Ophthalmol, 2006, 142:961-969.
10. Willerslev A, Munch IC, Larsen M. Resolution of diabetic papillopathy after a single intravitreal injection of ranibizumab[J]. Acta Ophthalmol, 2012, 90:407-409.
11. Gupta A, Bansal R, Gupta V, et al. Six-month visual outcome after pars plana vitrectomy in proliferative diabetic retinopathy with or without a single preoperative injection of intravitreal bevacizumab[J].Int Ophthalmol, 2012, 32:135-144.
12. Yeh PT, Yang CM, Lin YC, et al.Bevacizumab pretreatment in vitrectomy with silicone oil for severe diabetic retinopathy[J].Retina, 2009, 29:768-774.
13. Farahvash MS, Majidi AR, Roohipoor R, et al.Preoperative injection of intravitreal bevacizumab in dense diabetic vitreous hemorrhage[J]. Retina, 2011, 31:1254-1260.

Chinese Journal of Ocular Fundus Diseases

Microincision vitrectomy surgery and intravitreal injection of ranibizumab to treat severe proliferative diabetic retinopathy

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