Clinical Observation Of Vitrectomy Assisted With Preoperative Injection Of Intravitreal Ranibizumab For The Treatment Of Proliferative Diabetic Retinopathy

Objective:To investigate the effect of trans pars plana vitrectomy (TPPV) with or without preoperative intravitreal ranibizumab injection (IVR) for the treatment of proliferative diabetic retinopathy (PDR).Methods:A prospective study was carried out with PDR patients which were underwent 20G PPV at our hospital from January 2012 to February 2014. The 90 patients (90 eyes) were assigned to the Control group (TPPV only, n=43,43 eyes) and the Injection group (PPV combined with IVR, n=47,47 eyes). The IVR was 5-13d prior to PPV in the Injection group. The outcomes including the best corrected visual acuity (BCVA), duration of vitrectomy, intraoperative retinal hemorrhage, iatrogenic retinal tears and postoperative complication were compared. All patients were followed up 6 months.Results:1.Vision:(1) comparision between the Injection group and the Control group: â‘ the type of APDR involving the macular:The comparison of the 3mo,6mo BCVA after treatment between the two groups had a statistically significant difference (P<0.01); â‘¡the type of FPDR and APDR without involving the macular:The comparison of the 1mo,3mo,6mo BCVA after treatment between the two groups respectively had no statistical significance(P>0.05). (2) comparision within the group: â‘ the type of APDR without involving the macular:The comparison of 1mo,3mo,6mo BCVA after treatment between the preoperative BCVA respectively showed a statistically significant difference (P<0.05); â‘¡the type of FPDR and APDR involving the macular:The comparison of lmo,3mo,6mo BCVA after treatment between the preoperative BCVA respectively showed no statistical significance(P>0.05).2.Operation duration: â‘ the type of FPDR:The comparison of the operation duration between the two groups displayed a statistically significant difference (t=-8.30, P<0.01); â‘¡the type of APDR involving the macular:The comparison of the operation duration between the two groups had a statistically significant difference (t=-2.418, P<0.05); â‘¢the type of APDR without involving the macular:The comparison of the operation duration between the two groups existed no statistically significant difference (t=-1.685, P>0.05).3.Iatrogenic retinal tears: â‘ the type of FPDR:The comparison of the incidence of iatrogenic retinal tears between the two groups had no statistical difference (P=0.109,.P>0.05); â‘¡the type of APDR involving the macular:The comparison of the incidence of iatrogenic retinal tears between the two groups showed a statistical difference(P=0.029, P<0.05); â‘¢the type of APDR without involving the macular:The comparison of the incidence of iatrogenic retinal tears between the two groups had a statistical difference(P=0.019, P<0.05).4.Intraoperative retinal hemorrhage: â‘ the type of FPDR:The comparison of the incidence of intraoperative retinal hemorrhage between the two groups had no statistical difference (P=0.109,P>0.05); â‘¡the type of APDR involving the macular:The comparison of the incidence of intraoperative retinal hemorrhage between the two groups had a statistical difference(P=0.044, P<0.05); â‘¢the type of APDR without involving the macular:The comparison of the incidence of intraoperative retinal hemorrhage between the two groups had a statistical difference(P=0.035, P<0.05).5.Postoperative complication: â‘ the type of FPDR:The comparison of the incidence of early vitreous hemorrhage between the two groups had a statistical difference (P=0.041,P<0.05). The comparison of the incidence of late vitreous hemorrhage between the two groups had no statistical difference (P=0.272,P>0.05).â‘¡the type of APDR involving the macular:The comparison of the incidence of early vitreous hemorrhage between the two groups had a statistical difference (P=0.050,P<0.05). The comparison of the incidence of late vitreous hemorrhage between the two groups showed no statistical difference (P=0.295,P>0.05). â‘¢ the type of APDR without involving the macular:The comparison of the incidence of early. vitreous hemorrhage between the two groups existed a statistical difference (P=0.035,P< 0.05). The comparison of the incidence of late vitreous hemorrhage between the two groups had no statistical difference (P=0.433,P>0.05).Conclusion:1. PPV asisted with one preoperative IVB can improve the efficiency of the vitrectomy significantly by shortening the opration duration, decreasing the intraoperative complications and postoperive complications.2. PPV asisted with preoperative intravitreal ranibizumab can improve the BCVA of the type of APDR involving the macular after treatment furtherly.