Abstract
Currently, controversies regarding the optimal time-point of anti-vascular endothelial growth factor (VEGF) pretreatment before pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) still exist. To clarify this, we conducted a network meta-analysis, 26 randomized controlled trials including 1806 PDR patients were included. Compared with the sham group, performing anti-VEGF injection at preoperative (Pre-Op) 6 to 14 days could significantly improve post-operative best-corrected visual acuity (BCVA) and decrease the incidence of recurrent vitreous hemorrhage (VH). Meanwhile, it could significantly reduce the duration of surgery. Performing anti-VEGF injection at Pre-Op more than 14 days, 6 to 14 days or 1 to 5 days could significantly reduce the incidence of intra-operative bleeding, while no significant benefit existed at the end of PPV (P > 0.05). No significant difference existed between all those strategies and sham group in reducing the rate of silicone oil tamponade. Based on currently available evidence, performing the anti-VEGF pretreatment at pre-operative 6 to 14 days showed best efficacy in improving post-operative BCVA, reducing the duration of surgery and incidence of recurrent VH, it also achieves satisfactory effect in reducing the incidence of intra-operative bleeding.
Highlights
Controversies regarding the optimal time-point of anti-vascular endothelial growth factor (VEGF) pretreatment before pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) still exist
Abbreviations 95% CI 95% Confidence interval bestcorrected visual acuity (BCVA) Best-corrected visual acuity CS Complexity score DR Diabetic retinopathy ETDRS Early treatment diabetic retinopathy study NVM Neovascular membrane odds ratio (OR) Odds ratio PPV Pars Plana vitrectomy PDR Proliferative diabetic retinopathy performing anti-VEGF injection at preoperative (Pre-Op) Pre-operative Post-Op Post-operative randomized controlled trials (RCT) Randomized controlled trials RD Retinal detachment retinal neovascularization (RNV) Retinal neovascularization Intra-Op Intra-operative standardized mean difference (SMD) Standardized mean difference
The results of our study indicated that anti-VEGF injection at pre-operative 6 to 14 days showed the best efficacy in improving post-operative BCVA, reducing the duration of surgery and incidence of recurrent vitreous hemorrhage (VH), it achieves satisfactory effect in reducing the incidence of intra-operative bleeding
Summary
Controversies regarding the optimal time-point of anti-vascular endothelial growth factor (VEGF) pretreatment before pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) still exist. Compared with the sham group, performing anti-VEGF injection at preoperative (Pre-Op) 6 to 14 days could significantly improve post-operative bestcorrected visual acuity (BCVA) and decrease the incidence of recurrent vitreous hemorrhage (VH). It could significantly reduce the duration of surgery. Pars plana vitrectomy (PPV) combined with anti-vascular endothelial growth factor (VEGF) agents injections had been widely accepted to be the standard management for PDR patients complicated with VH or T RD5,6. Our previous meta-analysis[2] had confirmed the pretreatment of anti-VEGF agents before vitrectomy for patients with complicated PDR might achieve much smoother surgery and better visual rehabilitation, reduce the rate of early recurrent VH and accelerate its absorption
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