The effect of microincision vitrectomy and intravitreal injection of ranibizumab in the treatment of proliferative diabetic retinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

WeiYantao , JiangXintong , ZhangZhaotian , 周学智 , 邱梭 , 杨渊喆 ,  张少冲

Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China;

Corresponding author：

张少冲, Email: zhshaochong@sohu.com

Keywords：

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

DOI：

10.3760/cma.j.issn.1005-1015.2015.04.006

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Objective To observe the effect of microincision vitrectomy assisted with intravitreaI injection of ranibizumab (IVR) in proliferative diabetic retinopathy (PDR) treatment. Methods This is a prospective, randomized, and comparative case series study. A total of 92 patients (92 eyes) with PDR were recruited to have microincision vitrectomy with (combined group) or without (PPV group) IVR. There are 48 eyes in the combined group and 44 eyes in the PPV group. The average operation time, iatrogenic breaks, the use of tamponade and electric coagulation, postoperative bleeding and best corrected visual acuity were comparatively analyzed among the two groups.The mean follow-up was (14.3±5.2) months. Results The average operation time was (59.4±18.5) min in the combined group and (74.6±16.2) min in the PPV group. The rate of silicone oil tamponade (χ²=4.619), inert gas tamponade (χ²=4.290), electric coagulation (χ²=8.039) and iatrogenic breaks (χ²=4.330) in the combined group were significantly decreased compared with PPV group(P<0.05). The mean logMAR BCVA was 0.83±0.44 in the combined group and 1.37±0.53 in the PPV group, which significantly improved from preoperatively (t=3.257, 3.012; P<0.05). The rate of BCVA improvement in the combined group was significantly higher than that in the PPV group (t=2.972, P<0.05). The incidence of the recurrent vitreous hemorrhage was 2.1% in the combined group and 9.1% in the PPV group (χ²=6.741, P<0.05). There was no severe complication associated with surgery, such as choroidal detachment, retinal detachment and endophthal-mitis. Conclusion IVR before the microincision vitrectomy can shorten the operation time, reduce the use of electric coagulation and intraocular tamponade, and improve visual acuity for PDR patients.

Citation： WeiYantao, JiangXintong, ZhangZhaotian. The effect of microincision vitrectomy and intravitreal injection of ranibizumab in the treatment of proliferative diabetic retinopathy. Chinese Journal of Ocular Fundus Diseases, 2015, 31(4): 337-340. doi: 10.3760/cma.j.issn.1005-1015.2015.04.006 Copy

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2.	惠延年. 糖尿病视网膜病变并发症的玻璃体手术治疗和手术并发症控制[J]. 中华眼底病杂志,2007,23(4):231-233.
3.	Adamis AP,Miller JW,Bernal MT,et al. Increased vascular endothelial growth factor levels in the vitreous of eyes with proliferative diabetic retinopathy[J]. Am J Ophthalmol,1994,118(4):445-450.
4.	Aiello LP,Avery RL,Arrigg PG,et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders [J]. N Engl J Med,1994, 331(22):1480-1487.
5.	Mason JO 3rd, Nixon PA, White MF. Intravitreal injection of bevacizumab (Avastin) as adjunctivetreatment of proliferative diabetic retinopathy[J]. Am J Ophthalmol,2006,142(4): 685-688.
6.	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(11): 2218-2226.
7.	Oshima Y,Shima C,Wakabayashi T,et al. Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment[J].Ophthalmology,2009,116(5):927-938.
8.	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(1):42.
9.	Da R,Lucena D, Ribeiro JA, et al. Intraoperative bleeding during vitrectomy for diabetic tractional retinal detachment with versus without preoperative intravitreal bevacizumab (IBe Tra study)[J]. Br J Ophthalmol,2009,93(5):688-691.
10.	李筱荣,胡博杰,邵彦. 23G微创玻璃体切割手术治疗糖尿病视网膜病变的临床观察[J].中华眼底病杂志,2010,26(2): 173-174.
11.	Hershberger VS,Augsburger JJ,Hutchins RK,et al. Fibrovascular ingrowth at sclerotomy sites in vitrectomized diabetic eyes with recurrent vitreous hemorrhage: ultrasound biomicroscopy findings[J].Ophthalmology,2004,111(6):1215-1221.
12.	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(10):1943-1948.

1. Schachat AP,Oyakawa RT,Michels RG,et al. Complications of vitreous surgery for diabetic retinopathy Ⅱ:postoperative complications[J]. Ophthalmology,1983,90(5): 522-530.
2. 惠延年. 糖尿病视网膜病变并发症的玻璃体手术治疗和手术并发症控制[J]. 中华眼底病杂志,2007,23(4):231-233.
3. Adamis AP,Miller JW,Bernal MT,et al. Increased vascular endothelial growth factor levels in the vitreous of eyes with proliferative diabetic retinopathy[J]. Am J Ophthalmol,1994,118(4):445-450.
4. Aiello LP,Avery RL,Arrigg PG,et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders [J]. N Engl J Med,1994, 331(22):1480-1487.
5. Mason JO 3rd, Nixon PA, White MF. Intravitreal injection of bevacizumab (Avastin) as adjunctivetreatment of proliferative diabetic retinopathy[J]. Am J Ophthalmol,2006,142(4): 685-688.
6. 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(11): 2218-2226.
7. Oshima Y,Shima C,Wakabayashi T,et al. Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment[J].Ophthalmology,2009,116(5):927-938.
8. 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(1):42.
9. Da R,Lucena D, Ribeiro JA, et al. Intraoperative bleeding during vitrectomy for diabetic tractional retinal detachment with versus without preoperative intravitreal bevacizumab (IBe Tra study)[J]. Br J Ophthalmol,2009,93(5):688-691.
10. 李筱荣,胡博杰,邵彦. 23G微创玻璃体切割手术治疗糖尿病视网膜病变的临床观察[J].中华眼底病杂志,2010,26(2): 173-174.
11. Hershberger VS,Augsburger JJ,Hutchins RK,et al. Fibrovascular ingrowth at sclerotomy sites in vitrectomized diabetic eyes with recurrent vitreous hemorrhage: ultrasound biomicroscopy findings[J].Ophthalmology,2004,111(6):1215-1221.
12. 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(10):1943-1948.

Chinese Journal of Ocular Fundus Diseases

The effect of microincision vitrectomy and intravitreal injection of ranibizumab in the treatment of proliferative diabetic retinopathy

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