The effect of intravitreal injection of ranibizumab combined with vitrectomy to treat proliferative diabetic retinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

ZhuLi ,  ChenXiao , SongYanping , YanYing , HongLing , HuangZhijian , ZengMiao

Wuhan General Hospital of Guangzhou Military Command, Wuhan 430070;

Corresponding author：

ChenXiao, Email: chenxiao1972@sohu.com

Keywords：

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

DOI：

10.3760/cma.j.issn.1005-1015.2016.01.006

Video：

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Objective To observe the clinical effect of intravitreal ranibizumab (IVR) combined with vitrectomy in treating proliferative diabetic retinopathy (PDR). Methods This is a prospective non-randomized controlled clinical study. A total of 62 patients (70 eyes) who underwent vitrectomy for PDR were enrolled and divided into IVR group (30 patients, 34 eyes) and control group (32 patients, 36 eyes).IVR group patients received an intravitreal injection of 0.05 ml ranibizumab solution (10 mg/ml) 3 or 5 days before surgery. The follow-up time was 3 to 18 months with an average of (4.5±1.8) months. The surgical time, intraoperative bleeding, iatrogenic retinal breaks, use of silicone oil, the best corrected visual acuity (BCVA) and the incidence of postoperative complications were comparatively analyzed. Results The difference of mean surgical time (t=6.136) and the number of endodiathermy during vitrectomy (t=6.128) between IVR group and control group was statistically significant (P=0.000, 0.036). The number of iatrogenic retinal break in IVR group is 8.8% and control group is 27.8%, the difference was statistically significant (χ²=4.154, P=0.032). Use of silicone oil of IVR group is 14.7% and control group is 38.9%, the difference was statistically significant (χ²=5.171, P=0.023). The incidence of postoperative vitreous hemorrhage in 3 month after surgery was 11.8% and 30.6% respectively in IVR group and control group. The differences were statistically significant (χ²=3.932, P=0.047). The 6 month postoperative mean BCVA of IVR group and control group have all improved than their preoperative BCVA, the difference was statistically significant (t=4.414, 8.234; P=0.000).But there was no difference between the mean postoperative BCVA of two groups (t=0.111, P=0.190). There was no topical and systemic adverse reactions associated with the drug after injection in IVR group. Conclusions Microincision vitreoretinal surgery assisted by IVR for PDR shorten surgical time, reduces the intraoperative bleeding and iatrogenic retinal breaks, reduces the use of silicon oil and the postoperative recurrent vitreous hemorrhage. But there was no significant relationship between vision improvement and IVR.

Citation： ZhuLi, ChenXiao, SongYanping, YanYing, HongLing, HuangZhijian, ZengMiao. The effect of intravitreal injection of ranibizumab combined with vitrectomy to treat proliferative diabetic retinopathy. Chinese Journal of Ocular Fundus Diseases, 2016, 32(1): 22-25. doi: 10.3760/cma.j.issn.1005-1015.2016.01.006 Copy

1.	Abdelhakim MA, Mackv TA, Mansour KA, et al.Bevacizumab (Avastin) as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series[J].Ophthalmic Res, 2011, 45(1):23-30. DOI:10.1159/000314721.
2.	Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group, Martin DF, Maguire MG, et al.Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results[J].Ophthalmology, 2012, 119(7):1388-1398. DOI: 10.1016/j.ophtha.2012.03.053.
3.	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. DOI: 10.1016/j.ophtha.2011.03.036.
4.	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.DOI:10.1016/j.ophtha.2009.07.001.
5.	Chen E, Park CH.Use of intravitreal bevacizumab as a preoperative adjunct for tractional retinal detachment repair in severe proliferative diabetic retinopathy [J].Retina, 2006, 26(6):699-700.
6.	Farahvash MS, Majidi AR, Roohipoor R, et al.Preoperative injection of intravitreal bevacizumab in dense diabetic vitreous hemorrhage[J].Retina, 2011, 31(7):1254-1260. DOI: 10.1097/IAE.0b013e31820a68e5.
7.	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. Clinical guidelines of 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.
8.	Ishikawa K, Honda S, Tsukahara Y, et al.Preferable use of intravitreal bevacizumab as a pretreatment of vitrectomy for severe proliferative diabetic retinopathy [J]. Eye (Lond), 2009, 23(1):108-111.
9.	Guthrie G, Hall AB, Dhalla K, et al.Bevacizumab as an adjunct to vitreoretinal surgery for diabetic retinopathy in East Africa[J].Eye (Lond), 2013, 27(11):1263-1268. DOI: 10.1038/eye.2013.182.
10.	刘鹤南, 李迅, 濮伟, 等.手术前玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab预防增生型糖尿病视网膜病变玻璃体切割手术后玻璃体积血的meta分析[J].中华眼底病杂志, 2012, 28(3): 281-285.DOI:10.3760/cma.j.issn.1005-1015.2012.03.017.Liu HN, Li X, Pu W, et al.Intravitreal bevacizumab as a preoperative adjunct to vitrectomy for prevention of postoperative vitreous hemorrhage in proliferative diabetic retinopathy: a meta-analysis[J].Chin J Ocul Fundus Dis, 2012, 28(3):281-285.DOI:10.3760/cma.j.issn.1005-1015.2012.03.017.
11.	Lo WR, Kim SJ, Aaberg TM Sr, et al.Visual outcomes and incidence of recurrent vitreous hemorrhage after vitrectomy in diabetic eyes pretreated with bevacizumab (avastin)[J].Retina, 2009, 29(7):926-931. DOI: 10.1097/IAE.0b013e3181a8eb88.
12.	Zhang ZH, Liu HY, Hernandez-Da Mota SE, et al.Vitrectomy with or without preoperative intravitreal bevacizumab for proliferative diabetic retinopathy: a meta-analysis of randomized controlled trials[J].Am J Ophthalmol, 2013, 156(1): 106-115. DOI: 10.1016/j.ajo.2013.02.008.
13.	王德功, 陈松, 王昀, 等.玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab辅助微创玻璃体视网膜手术治疗严重PDR的临床观察[J].中华跟底病杂志, 2014, 30(2): 137-140.DOI:10.3760/cma.j.issn.1005-1015.2014.02.005.Wang DG, Chen S, Wang Y, et al.Microincision vitrectomy surgery and intravitreal injection of ranibizumab to treat severe proliferative diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2014, 30(2):137-140.DOI:10.3760/cma.j.issn.1005-1015.2014.02.005.

1. Abdelhakim MA, Mackv TA, Mansour KA, et al.Bevacizumab (Avastin) as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series[J].Ophthalmic Res, 2011, 45(1):23-30. DOI:10.1159/000314721.
2. Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group, Martin DF, Maguire MG, et al.Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results[J].Ophthalmology, 2012, 119(7):1388-1398. DOI: 10.1016/j.ophtha.2012.03.053.
3. 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. DOI: 10.1016/j.ophtha.2011.03.036.
4. 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.DOI:10.1016/j.ophtha.2009.07.001.
5. Chen E, Park CH.Use of intravitreal bevacizumab as a preoperative adjunct for tractional retinal detachment repair in severe proliferative diabetic retinopathy [J].Retina, 2006, 26(6):699-700.
6. Farahvash MS, Majidi AR, Roohipoor R, et al.Preoperative injection of intravitreal bevacizumab in dense diabetic vitreous hemorrhage[J].Retina, 2011, 31(7):1254-1260. DOI: 10.1097/IAE.0b013e31820a68e5.
7. 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. Clinical guidelines of 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.
8. Ishikawa K, Honda S, Tsukahara Y, et al.Preferable use of intravitreal bevacizumab as a pretreatment of vitrectomy for severe proliferative diabetic retinopathy [J]. Eye (Lond), 2009, 23(1):108-111.
9. Guthrie G, Hall AB, Dhalla K, et al.Bevacizumab as an adjunct to vitreoretinal surgery for diabetic retinopathy in East Africa[J].Eye (Lond), 2013, 27(11):1263-1268. DOI: 10.1038/eye.2013.182.
10. 刘鹤南, 李迅, 濮伟, 等.手术前玻璃体腔注射抗血管内皮生长因子单克隆抗体bevacizumab预防增生型糖尿病视网膜病变玻璃体切割手术后玻璃体积血的meta分析[J].中华眼底病杂志, 2012, 28(3): 281-285.DOI:10.3760/cma.j.issn.1005-1015.2012.03.017.Liu HN, Li X, Pu W, et al.Intravitreal bevacizumab as a preoperative adjunct to vitrectomy for prevention of postoperative vitreous hemorrhage in proliferative diabetic retinopathy: a meta-analysis[J].Chin J Ocul Fundus Dis, 2012, 28(3):281-285.DOI:10.3760/cma.j.issn.1005-1015.2012.03.017.
11. Lo WR, Kim SJ, Aaberg TM Sr, et al.Visual outcomes and incidence of recurrent vitreous hemorrhage after vitrectomy in diabetic eyes pretreated with bevacizumab (avastin)[J].Retina, 2009, 29(7):926-931. DOI: 10.1097/IAE.0b013e3181a8eb88.
12. Zhang ZH, Liu HY, Hernandez-Da Mota SE, et al.Vitrectomy with or without preoperative intravitreal bevacizumab for proliferative diabetic retinopathy: a meta-analysis of randomized controlled trials[J].Am J Ophthalmol, 2013, 156(1): 106-115. DOI: 10.1016/j.ajo.2013.02.008.
13. 王德功, 陈松, 王昀, 等.玻璃体腔注射抗血管内皮生长因子单克隆抗体ranibizumab辅助微创玻璃体视网膜手术治疗严重PDR的临床观察[J].中华跟底病杂志, 2014, 30(2): 137-140.DOI:10.3760/cma.j.issn.1005-1015.2014.02.005.Wang DG, Chen S, Wang Y, et al.Microincision vitrectomy surgery and intravitreal injection of ranibizumab to treat severe proliferative diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2014, 30(2):137-140.DOI:10.3760/cma.j.issn.1005-1015.2014.02.005.

Chinese Journal of Ocular Fundus Diseases

The effect of intravitreal injection of ranibizumab combined with vitrectomy to treat proliferative diabetic retinopathy

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