| Objective:To assess the effects of preoperative and intraoperative intravitreal ranibizumab(IVR)injection after pars plana vitrectomy for proliferative diabetic retinopathy(PDR).Methods:This was a prospective,comparative,and randomized study.Ninety seven eyes of97 patients were enrolled and randomly assigned to three different treatment groups:30 eyes(30 patients)in the preoperative IVR group,32 eyes(32 patients)in the intraoperative IVR group and 35 eyes(35 patients)in the no IVR injection group.All eyes enrolled that undergoing the conventional 23-gauge pars plana vitrectomy(PPV).The preoperative and intraoperative IVR group patients respectively received an intravitreal injection of 0.05 ml ranibizumab solution(10 mg/ml)3 to 7 days before PPV or at the end of PPV.The no IVR injection group patients only received23 G PPV and without any drug injection.The primary outcome of BCVA ?postoperative vitreous hemorrhage(VH)and the postoperative foveal thicknesses central(CFT)?FFA were compared among the three treatment groups.Results:The mean BCVA before operation was respectively(1.82±0.6)?(1.93±0.5)?(1.75±0.4)in the preoperative,intraoperative injection group,and non-drug injection group(F=0.18,P>0.05).The mean BCVA were all improved among the 3 groups compared with the preoperative BCVA at 1 months after operation.At the beginning of the 3 month after surgery,the average BCVA of the preoperative injection group and the intraoperative injection group tended to stable;while 3 eyes in the non-drug in jection group began to decreased.There was no significant difference in average BCVA at 1?3?12 months of follow-up periods among the 3 groups(F=1.42?1.17?0.26,P>0.05).The incidences of early RVH was respectively 16.7%? 9.4%? 28.6% in the preoperative,intraoperative injection group,and non-drug injection group(?2=5.12,P<0.05).The incidences of late recurrent VH were respectively 13.3%?9.4%?14.3%in three groups(?2=0.47,P>0.05).The average CFT was respectively(325.0±46.7)?(321.0±29.9)and(369.0±59.9)?m in the preoperative,intraoperative injection group,and non-drug injection group at 1 week.The average CFT was decreased among the 3 groups in different degrees at 1 months when compared with that of 1 week after operation and the decreasing was statistically significant(F=59.50,P<0.05).A subgroup pairwise analysis showed no significant difference of decreasing CFT in pre-injection group compared with that of intrao-injection group(t=0.23,P>0.05).The average CFT of the3 groups had different degrees of thickening at 3,6,9,12 months after surgery,the increasing of CFT among the 3 groups were not differ significantly(F=2.92?2.86?3.07?3.12,P>0.05).At 1 months,65 of 97 cases were examined by fundus fluorescein angiography(FFA),respectively 20 eyes in the preoperative IVR group,21 eyes in the intraoperative IVR group,and 24 eyes in the no injection group.There are 4 eyes,3eyes,12 eyes of <1PD fluorescein leakage respectively in the preoperative injection group,intraoperative injection group and drug injection group,respectively accounted for corresponding groups accept the number 20.00%,14.00% and 50.00%.The differences among the three groups have statistical significance(?2= 4.91,P <0.05).Conclusion:The adjunctive use of IVR can reduce the incidence of early postoperative RVH in vitrectomy for PDR.It is beneficial to decrease the CFT,diabetic macular edema(DME)and obtian favorable visual recovery in the short term.The number of new blood vessel leakage was significantly less in IVR injection groups than that of the no injection group at one month after the operation.The visual recovery and incidence of early RVH of preoperative IVR injection group was slightly better than that of the intraoperative IVR injection group patients.Ranibizumab injections is of higher security. |
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