Analysis On Influence Of Intravitreal Avastin Combined With Vitrectomy For Diabetic Ratinopathy

Diabetic retinopathy(DR) is one of common serious complications of diabetes,is a retinal microvascular occlusive disease mainly characterized by disorder, which is closely related to high blood glucose level and duration. As the disease progresses,it often leads to retinal hemorrhage, retinal fibrous tissue proliferation, vitreous hemorrhage or opacity, traction retinal detachment and other complications.In recent years, the global incidence of diabetes increased rapidly, diabetic also increased rapidly in China, increased the number of blindness. Proliferative diabetic retinopathy(PDR) is terminal stage of diabetic retinopathy, which has become the leading cause of blindness.The investigations of wisconsin epidemiological study of diabetic retinopathy(WESDR) in 1984 revealed that the prevalence of DR is 28.8% and the prevalence of PDR is 2% with the duration of diabetes less than 5 years,the prevalence of DR is 77.8% and the prevalence of PDR is 15.5% with the duration of diabetes more than 15 years.The mechanism of DR is not fully clear, glucose metabolism disorders are the root causes of DR. The current agreement is that as a result of retinal microvascular disease, DR is due to endocrine, metabolic and other systems damaged. The basic pathological changes of fundus including basement membrane of retinal capillary endothelial cells become thicker, pericyte loss, endothelial cells proliferate, endothelial cells block, retinal microaneurysms thrombosis, capillary permeability increse and neovascularization. These changes lead into retinal hypoxia,ischemia,bleeding is caused by rupture of retinal neovascularization, further result in the integrity of vitreoretinal anatomy and blood-retinal barrier destruction, retinal pigment epithelium(RPE) is exposed to the vitreous body,neovascularization grow in the vitreous body. Serum protein, white blood cells and various growth factors enter into the vitreous cavity and begin their work.Recently, the effect of intravitreal Avastin before vitrectomy has aroused wide concern. Domestic experts have conducted such a study phase. Objective:To evaluate the effect of intravitreal Avastin combined with vitrectomy for diabetic ratinopathy.Methods:The clinical datum of sixty-two eyes of fifty-four patients'who were cured by the same medical group in 1st Department of ocular fundus disease in our hospital were studied from Oct,2008 to Dec,2009. According to whether the application of preoperative Avastin,they were divided into the injection group and control group. Among them,28 patients(31 eyes) first underwent intravitreal Avastin before vitrectomy,another 26 patients(31 eyes) direct underwent vitrectomy.Results:No obvious ocular and systemic complications took place after intravitreal Avastin.Retinal neovascularization fibrosed and atrophied after 5-7 days.Membrane proliferation was easily stripped during vitrectomy. The case of intraoperative bleeding and iatrogenic retinal breaks significantly reduced. Average operative time was significantly shorter than control group. The degree of visual acuity improvement was better than control group.The risk of postoperative bleeding was reduced. All cases completed a postoperative FFA follow-up of 3-6months, the incidence of macular edema,large non-perfusion and neovascular leakage was less than control group patients.Conclusions:1.PDR patients'retinal neovascularization fibrosed and atrophied after intravitreal Avastin.2.Intravitreal Avastin combined with vitrectomy for PDR can increase vitrectomy efficiency, saving surgical time,reduce bleeding and other complications.3.PDR patients'visual acuity can be well improved by intravitreal Avastin combined with vitrectomy. It also can inhibit the progress of PDR.4.Intravitreal Avastin has high security.5.It is worth exploring that when should vitrectomy be done after intravitreal Avastin.