ObjectiveTo observe the clinical effect of intravitreal ranibizumab (IVR) combined with vitrectomy in treating proliferative diabetic retinopathy (PDR). MethodsThis 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. ResultsThe 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. ConclusionsMicroincision 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.
ObjectiveTo compare clinical outcomes in eyes with macula-off rhegmatogenous retinal detachments (RRD) with peripheral breaks managed by surgical protocols that result in either complete (CSFD) or partial subretinal fluid drainage (PSFD). MethodsFollowing the clinical detection of a macula-off RRD with peripheral retinal breaks, patients were offered the opportunity to enroll in the study, and those patients who signed the consent were evaluated for eligibility based upon the inclusion and exclusion criteria for this clinical study, and if fully eligible they were assigned prospectively to one of the two surgical designs (PSFD or CSFD, 1:1) using a random number table. Seventy-two eyes of 72 patients were enrolled and studied. Patients were treated with 25G plus vitrectomy, endolaser or transscleral cryopexy, either complete (n=36), or partial (n=36) subretinal fluid drainage, and 14%C3F8 (PFO) was used for intraocular tamponade. After surgery, all patients were kept in a supine position for 24 hours, and then in a clinically optimal position for 6-10 days. The study patients were examined at 1, 3 and 6 months after surgery with thorough ophthalmic examinations. Macular optical coherence tomography (OCT) imaging was acquired in 1 month. Anatomical and visual outcomes as well as intra-operative and postoperative complications of the two groups were compared. Furthermore, the persistence of subfoveal fluid in OCT images and the symptoms of distortion at 3 months were measured and recorded. The primary study endpoint of anatomic retinal reattachment for each group was based upon the 6-month time-point. ResultsThe preoperative baseline characteristics between the two groups were not significantly different. The single-operation success rates were 88.9% and 91.6% respectively for the CSFD and the PSFD groups (χ2=0.158, P>0.05). The mean best corrected visual acuity (BCVA) at 6 month endpoint were 0.99±0.52 minimum resoluation angle in logarithmic (logMAR) for the CSFD group and 1.07±0.34 logMAR for the PSFD group(t=0.580,P=0.564). The mean operative time was longer in the CSFD group (62.25±4.32) minutes than that in the PSFD group (47.9±5.0) minutes (t=0.580, P=0.564). seven of 29 (24.1%) phakic eyes in the CSFD group had lens injury during SRF drainage, and none of the 31-phakic eyes in the PSFD group sustained lens damage. Residual PFO was present in 6 of 36 CSFD cases (16.7%). Successful retinal reattachment after primary surgery was achieved in 33) PSFD eyes and in 32 CSFD eyes based upon OCT imaging at 1 month demonstrated reattached foveae with no residual subfoveal fluid. Among these patients, 22 patients (62.5%) in the CSFD group and 23(69.7%) patients in the PSFD group reported distortion in the operated eye or/and a difference in image size between the two eyes at the 6 month visit (P=1.00). ConclusionsPartial subretinal fluid drainage during pars plana vitrectomy for the repair of macula-off RRD with peripheral breaks is effective. The success rates are not statistically different. Additionally, PSFD procedures can simplify the surgery procedure, shorten operative time and, and to some extent, reduce the incidence of complications relevant to the CSFD approach.