Effect of Ranibizumab intravitreal injection as an adjunct before vitrectomy surgery in the treatment of patients with proliferative diabetic retinopathy

Abstract:

AIM: To evaluate the effect of preoperative intravitreal injection of Ranibizumab in patients undergoing pars plana vitrectomy for proliferative diabetic retinopathy(PDR).

METHODS: In this retrospective research, 52 patients(52 eyes)with PDR in Peking Union Medical College Hospital from April 2013 to August 2014 were recruited. The experimental group included 23 eyes treated with ranibizumab intravitreal injection, 0.5mg, 6～14d before vitrectomy, and 29 eyes underwent direct vitrectomy were analyzed as control group. Main outcome measures were surgical time, intraoperative hemorrhage, incidence of iatrogenic retinal breaks, types of tamponade, and percentage of reoperation were recorded. Visual acuity at pre-operative, post-operative and last follow-up were observed.

RESULTS: Mean surgical time was 70.52±26.18min in experimental group vs 99.45±27.75min in control group(t=-3.827, P=0.000); intraoperative bleeding 5 eyes(21.7%)vs 19 eyes(65.5%),(χ²=9.892, P=0.002); iatrogenic retinal breaks 3 eyes(13.0%)vs 15 eyes(51.7%),(χ²=8.479, P=0.004); silicone oil tampanade 8 eyes(34.8%)vs 19 eyes(65.5%),(χ²=4.854, P=0.028). No complications were recorded after intravitreal ranibizumab. Post-operative visual acuity and visual acuity at last follow-up elevated to some extent contrast to pre-operative visual acuity, there were 20 eyes(86.9%)in experimental group which visual acuity at last follow-up ≥0.1 vs 16 eyes(55.2%)in control group. Mean pre-operative visual acuity, post-operative visual acuity were not significantly different separately(t=-1.659,

-0.084; P=0.103, 0.933); visual acuity at last follow-up was significantly different between two groups(t=-2.662, P=0.010).

CONCLUSION: Ranibizumab intravitreal injection as an adjunct before vitrectomy in the treatment of patients with PDR can facilitate vitrectomy procedures, reduce active neovascularization, minimize the incidence of intraoperative haemorrhage and iatrogenic retinal breaks and shorten the operation time significantly, finally, benefits in improving visual outcome.