The effect of preoperative intravitreal ranibizumab injection on the operation duration of vitrectomy and postoperative vision for the treatment of proliferative diabetic retinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

FuWeina , ChenMeizhu ,  WangYunpeng

Department of Ophthalmology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou 350025;

Corresponding author：

WangYunpeng, Email: 34165596@qq.com

Keywords：

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

DOI：

10.3760/cma.j.issn.1005-1015.2016.01.007

Video：

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Objective To observe the effect of preoperative intravitreal ranibizumab injection (IVR) on the operation duration of vitrectomy and postoperative vision for the treatment of proliferative diabetic retinopathy (PDR). Methods A prospective study was carried out with the 90 PDR patients (90 eyes) who underwent vitrectomy. The 90 patients(90 eyes)were assigned to the vitrectomy only group(43 eyes) and the IVR combined with vitrectomy group (47 eyes). The IVR was performed 5-13 days prior to vitrectomy in the IVR combined with vitrectomy group. There were 15 eyes with fibrous proliferation PDR (FPDR), 16 eyes with advanced PDR (APDR) without involving the macular and 16 eyes with APDR involving the macular in the vitrectomy only group. There were 14 eyes with FPDR, 15 eyes with APDR without involving the macular and 14 eyes with APDR involving the macular patients in the IVR combined with vitrectomy group. All the eyes in the two groups were regularly operated by the same doctor to complete the vitrectomy. The start and end time of vitrectomy were recorded. The average follow-up time was 10 months. The changes of best corrected visual acuity (BCVA) before and 1, 3 and 6 months after surgery were compared between the two groups. Results The duration of operation of the FPDR type (t=-8.300) and the APDR involving the macular type (t=-2.418) in the IVR combined with vitrectomy group was shorter than vitrectomy only group (P < 0.05). The comparison of duration of operation of the APDR without involving the macular type in the two groups has no statistically significant difference (t=-1.685, P > 0.05). At 1 month after surgery, the comparison of BCVA of the IVR combined vitrectomy group and the vitrectomy only group in APDR involving the macular type has no statistically significant difference (t=0.126, P > 0.05). At 3, 6 months after surgery, the BCVA of the IVR combined vitrectomy group in APDR involving the macular type was significantly better than the BCVA of the vitrectomy only group (t=8.014, 7.808; P < 0.05). At 1, 3, and 6 months after surgery, the BCVA of the IVR combined vitrectomy group in FPDR type (t=3.809, 1.831, 0.600) and APDR without involving the macular type (t=0.003, 1.092, 3.931) compared with pre-treatment, the difference were not statistically significant (P > 0.05); the BCVA in APDR without involving the macular type compared with pre-treatment, the difference was distinctly statistically significant (t=2.940, 4.162, 6.446; P < 0.05); the BCVA in APDR involving the macular type (t=0.953, 1.682, 1.835) compared with pre-treatment, the difference were not statistically significant (P > 0.05). Conclusion Preoperative IVR of PDR can shorten the operation duration and improve the BCVA of APDR involving the macular type.

Citation： FuWeina, ChenMeizhu, WangYunpeng. The effect of preoperative intravitreal ranibizumab injection on the operation duration of vitrectomy and postoperative vision for the treatment of proliferative diabetic retinopathy. Chinese Journal of Ocular Fundus Diseases, 2016, 32(1): 26-30. doi: 10.3760/cma.j.issn.1005-1015.2016.01.007 Copy

1.	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. DOI: 10.1016/j.ophtha.2008.11.005.
2.	Yeoh J, Williams C, Allen P, et al. Avastin as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series[J]. Clin Experiment Ophthalmol, 2008, 36(5): 449-454.
3.	Holladay JT. Proper method for caculating average visual acuity[J]. J Refract Surg, 1997, 13(4): 388-391.
4.	中华医学会眼科学会眼底病学组.我国糖尿病视网膜病变临床诊疗指南(2014年)[J].中华眼科杂志, 2014, 50(11):851-865.DOI:10.3760/cma.j.issn.0412-4081.2014.11.014.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. The clinical diagnosis and treatment guidelines for diabetic retinopathy in China (2014)[J]. Chin J Ophthalmol, 2014, 50(11) 851-865. DOI:10.3760/cma.j.issn.0412-4081.2014.11.014.
5.	Pece A, Isola V, Piermarocchi S, et al. Efficacy and safty of anti-vascular endothelial growth factor (VEGF) therapy with intravitreal ranibizumab (Lucentis) for naive retinal vein occlusion:1-year follow-up[J]. Br J Ophthalmol, 2011, 95(1): 56-68. DOI: 10.1136/bjo.2009.174060.
6.	Abegg M, Tappeiner C, Wolf-Schnurrbusch U, et al. Treatment of branch retinal vein occlusion induced macular edema with bavacizumab[J]. BMC Ophthalmol, 2008, 8(9):18. DOI: 10.1186/1471-2415-8-18.
7.	Pacella E, Pacella F, La torre G, et al. Testing the effectiveness of intravitreal Ranibizumab during 12 months of follow-up in venous occlusion treatment[J]. Clin Ter, 2012, 163(6): 413-422.
8.	Campochiaro PA, Sophie R, Pearlman J, et al. Long-term outcomes in patients with retinal vein occlusion treated with ranibizumab:the RETAIN study[J]. Ophthalmology, 2014, 121(1): 209-219. DOI: 10.1016/j.ophtha.2013.08.038.
9.	Pieramici DJ, Rabena M, Castellarin AA, et al. Ranibizumab for the treatment of macular edema associated with perfused central retinal vein occlusions[J]. Ophthalmology, 2008, 115(10): 47-54. DOI: 10.1016/j.ophtha.2008.06.021.
10.	Rouvas A, Petrou P, Ntouraki A, et al. Intravitreal ranibizumab(Lucentis) for baranch retinal vein occlusion-induced macular edema:nine-month results of a prospective study[J]. Retina, 2010, 30(6): 893-902. DOI: 10.1097/IAE.0b013e3181cd4894.
11.	Mitropoulos PG, Chatziralli IP, Parikakis EA, et al. Intravitreal ranibizumab for stageⅣproliferative sickle cell retinopathy: a first case report. Case Rep Ophthalmol Med, 2014, 2014:682583. http://www.hindawi.com/journals/criopm/2014/682583/. DOI: 10.1155/2014/682583.
12.	Pakzad-vaezi K, Albiani DA, Kirker AW, et al. A randomized study comparing the efficacy of bevacizumab and ranibizumab as pre-treatment for pars plana vitrectomy in proliferative diabetic retinopathy[J]. Ophthalmic Surg Lasers Imaging Retina, 2014, 45(6): 521-524. DOI: 10.3928/23258160-20141118-06.
13.	禹海, 李鹤一, 王颖, 等.雷珠单抗玻璃体注射与玻璃体切除术治疗增殖性糖尿病视网膜病变[J].中国实用眼科杂志, 2014, 32(11):1301-1305. DOI:10.3760/cma.j.issn.1006-4443.2014.011.010.Yu H, Li HY, Wang Y, et al. The effect of intravitreal ranibizumab combined with vitrectomy for proliferative diabetic retinopathy[J]. Chin J Pract Ophthalmol, 2014, 32(11):1301-1305.DOI:10.3760/cma.j.issn.1006-4443.2014.011.010.
14.	赵抒羽, 梁先军, 林英杰, 等.增生期糖尿病视网膜病变围手术期注射雷珠单抗的临床观察[J].临床眼科杂志, 2014(3):237-240.DOI:10.3969/j.issn.1006-8422.2014.03.015.Zhao SY, Liang XJ, Lin YJ, et al. Pars plana vitrectomy assisted with lucentis for proliferative diabetic retinopathy[J]. J Clin Ophthalmol, 2014(3):237-240. DOI:10.3969/j.issn.1006-8422.2014.03.015.
15.	章晖, 叶波, 邱新文, 等.雷珠单抗辅助23G玻璃体切割术治疗增生性糖尿病视网膜病变[J].眼科新进展, 2014, 34(10):975-977. DOI:10.13389/j.cnki.rao.2014.0270.Zhang H, Ye B, Qiu XW, et al. Ranibizumab assisted 23G vitrectomy for proliferative diabetic retinopathy[J]. Rec Adv Ophthalmol, 2014, 34(10):975-977. DOI:10.13389/j.cnki.rao.2014.0270.
16.	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(4): 636-641. DOI: 10.1016/j.ophtha.2010.08.038.
17.	Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, et al. Anti-vascular endothelial growth factor for proliferative diabetic retinopathy. Cochrane Database Syst Rev, 2014, 11:CD008721.https://www.nlm.nih.gov/medlineplus/diabeticeyeproblems.html. DOI: 10.1002/14651858.CD008721.pub2.

1. 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. DOI: 10.1016/j.ophtha.2008.11.005.
2. Yeoh J, Williams C, Allen P, et al. Avastin as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series[J]. Clin Experiment Ophthalmol, 2008, 36(5): 449-454.
3. Holladay JT. Proper method for caculating average visual acuity[J]. J Refract Surg, 1997, 13(4): 388-391.
4. 中华医学会眼科学会眼底病学组.我国糖尿病视网膜病变临床诊疗指南(2014年)[J].中华眼科杂志, 2014, 50(11):851-865.DOI:10.3760/cma.j.issn.0412-4081.2014.11.014.Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association. The clinical diagnosis and treatment guidelines for diabetic retinopathy in China (2014)[J]. Chin J Ophthalmol, 2014, 50(11) 851-865. DOI:10.3760/cma.j.issn.0412-4081.2014.11.014.
5. Pece A, Isola V, Piermarocchi S, et al. Efficacy and safty of anti-vascular endothelial growth factor (VEGF) therapy with intravitreal ranibizumab (Lucentis) for naive retinal vein occlusion:1-year follow-up[J]. Br J Ophthalmol, 2011, 95(1): 56-68. DOI: 10.1136/bjo.2009.174060.
6. Abegg M, Tappeiner C, Wolf-Schnurrbusch U, et al. Treatment of branch retinal vein occlusion induced macular edema with bavacizumab[J]. BMC Ophthalmol, 2008, 8(9):18. DOI: 10.1186/1471-2415-8-18.
7. Pacella E, Pacella F, La torre G, et al. Testing the effectiveness of intravitreal Ranibizumab during 12 months of follow-up in venous occlusion treatment[J]. Clin Ter, 2012, 163(6): 413-422.
8. Campochiaro PA, Sophie R, Pearlman J, et al. Long-term outcomes in patients with retinal vein occlusion treated with ranibizumab:the RETAIN study[J]. Ophthalmology, 2014, 121(1): 209-219. DOI: 10.1016/j.ophtha.2013.08.038.
9. Pieramici DJ, Rabena M, Castellarin AA, et al. Ranibizumab for the treatment of macular edema associated with perfused central retinal vein occlusions[J]. Ophthalmology, 2008, 115(10): 47-54. DOI: 10.1016/j.ophtha.2008.06.021.
10. Rouvas A, Petrou P, Ntouraki A, et al. Intravitreal ranibizumab(Lucentis) for baranch retinal vein occlusion-induced macular edema:nine-month results of a prospective study[J]. Retina, 2010, 30(6): 893-902. DOI: 10.1097/IAE.0b013e3181cd4894.
11. Mitropoulos PG, Chatziralli IP, Parikakis EA, et al. Intravitreal ranibizumab for stageⅣproliferative sickle cell retinopathy: a first case report. Case Rep Ophthalmol Med, 2014, 2014:682583. http://www.hindawi.com/journals/criopm/2014/682583/. DOI: 10.1155/2014/682583.
12. Pakzad-vaezi K, Albiani DA, Kirker AW, et al. A randomized study comparing the efficacy of bevacizumab and ranibizumab as pre-treatment for pars plana vitrectomy in proliferative diabetic retinopathy[J]. Ophthalmic Surg Lasers Imaging Retina, 2014, 45(6): 521-524. DOI: 10.3928/23258160-20141118-06.
13. 禹海, 李鹤一, 王颖, 等.雷珠单抗玻璃体注射与玻璃体切除术治疗增殖性糖尿病视网膜病变[J].中国实用眼科杂志, 2014, 32(11):1301-1305. DOI:10.3760/cma.j.issn.1006-4443.2014.011.010.Yu H, Li HY, Wang Y, et al. The effect of intravitreal ranibizumab combined with vitrectomy for proliferative diabetic retinopathy[J]. Chin J Pract Ophthalmol, 2014, 32(11):1301-1305.DOI:10.3760/cma.j.issn.1006-4443.2014.011.010.
14. 赵抒羽, 梁先军, 林英杰, 等.增生期糖尿病视网膜病变围手术期注射雷珠单抗的临床观察[J].临床眼科杂志, 2014(3):237-240.DOI:10.3969/j.issn.1006-8422.2014.03.015.Zhao SY, Liang XJ, Lin YJ, et al. Pars plana vitrectomy assisted with lucentis for proliferative diabetic retinopathy[J]. J Clin Ophthalmol, 2014(3):237-240. DOI:10.3969/j.issn.1006-8422.2014.03.015.
15. 章晖, 叶波, 邱新文, 等.雷珠单抗辅助23G玻璃体切割术治疗增生性糖尿病视网膜病变[J].眼科新进展, 2014, 34(10):975-977. DOI:10.13389/j.cnki.rao.2014.0270.Zhang H, Ye B, Qiu XW, et al. Ranibizumab assisted 23G vitrectomy for proliferative diabetic retinopathy[J]. Rec Adv Ophthalmol, 2014, 34(10):975-977. DOI:10.13389/j.cnki.rao.2014.0270.
16. 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(4): 636-641. DOI: 10.1016/j.ophtha.2010.08.038.
17. Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, et al. Anti-vascular endothelial growth factor for proliferative diabetic retinopathy. Cochrane Database Syst Rev, 2014, 11:CD008721.https://www.nlm.nih.gov/medlineplus/diabeticeyeproblems.html. DOI: 10.1002/14651858.CD008721.pub2.

Chinese Journal of Ocular Fundus Diseases

The effect of preoperative intravitreal ranibizumab injection on the operation duration of vitrectomy and postoperative vision for the treatment of proliferative diabetic retinopathy

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