The clinical study of intravitreal Ranibizumab injection before vitrectomy for proliferative diabetic retinopathy

Abstract

Objective To investigate the therapeutic effect of 25 G+ vitrectomy assisted with preoperative intravitreal injection of Ranibizumab for the treatment of proliferative diabetic retinopathy. Methods A prospective controled analysis in 74 eyes of 73 cases with proliferative diabetic retinopathy treated by vitrectomy from May 2013 to January 2015 was performed. Thirty-four eyes of 33 cases with proliferative diabetic retinopathy received intravitreal injection of Ranibizumab 0.05ml(contain ranibizumab 0.5mg)at 5 to 7 days before the vitrectomy in group A. Forty eyes of 40 cases with proliferative diabetic retinopathy were treated by vitrectomy only as non-injection group (group B). The operative time, hemorrhage during the operation, times of endodiathermy, incidence of iatrogenic retinal tear, kinds of intraocular filling materials, postoperative visual acuity and complications between the two groups were compared. Results The average operation time in group A was (92.0±19.5)min less than (121±26.3)min in group B , the difference was statistically significant (t=6.837, P=0.041) .Hemorrhage during the operation were observed in 9 eyes in group A (26.5%), and 24 eyes(60.0%) in group B(χ2=8.362, P=0.005) .Endodiathermy was used 16 times in group A, and 47 times in group B(t=2.216, P=0.032). The iatrogenic retinal tear occurred in 4 eyes(11.8%) in group A, and 7eyes(17.5%)in group B(χ2=0.478, P=0.533). The kinds of intraocular filling materials were silicone oil instillation in 14 eyes (41.2%), expanding gas instillation in 4 eyes(11.8%), balanced salt solution in 16 eyes(47.1%)in group A, and silicone oil instillation in 27 eyes (67.5%), expanding gas instillation in 4 eyes(10.0%), and balanced salt solution in 9 eyes(22.2%)in group B(χ2=5.632, P=0.060). The vision of group A was better than that of group B(χ2=8.527, P=0.014). There was no difference at 3d and 2weeks after sugery between the vision of two groups. There was no one complicated with vitreous hemorrhage postoperatively in group B, but 4 eyes had that in group A, the difference was not significant (Fisher P=0.120). Conclusion Vitrectomy assisted with preoperative intravitreal injection of Ranibizumab can decrease the operation time, reduce the incidence of hemorrhage during the operation, and obtain better visual acuity in the treatment of proliferative diabetic retinopathy. Key words: Diabetic retinopathy, proliferative; Vitrectomy, 25 G+; Ranibizumab, intrevitreal injection, before surgery