The Clinic Study Of Perioperative Intravitreal Conbercept Injection For Decreasing The Intraoperative Complication Ofproliferative Diabetic Retinopathy

Purpose: To evaluate the effectiveness and role of perioperative intravitreal conbercept injection as an additional measure to vitrectomy in the management of proliferative diabetic retinopathy for decreasing the intraoperative complication.Methods: A retrospective analysis was performed on 41 eyes of 39 patients cured in The First affiliated hospital of Fujian Medical university from January 2014 to December 2015, who diagnosed as proliferative diabetic retinopathy and affected by angiogenesis, vitreous hemorrhage(VH), proliferative membranes and tractional retinal detachment(TRD). In the trial, there were 15 males and 26 females conforming to the diagnosis of diabetes. All patients were diagnosed as diabetes and the Glycated Hemoglobin A1c(Hb A1c) fluctuating in 4.60 ~ 11.80(average 7.54 + /- 1.30). The patients took the exams of visual acuity, intraocular pressure, supplementary lens after mydriasis, color fundus photography, eye color Doppler ultrasound, routine blood examination. All patients underwent the examinations of the best corrected visual acuity(BCVA). There were 12 eyes in hand movement, 20 eyes in finger-counting, 3 eyes in 0.02? BCVA<0. 05,0 eye in 0.05? BCVA<0.1, 5 eyes 0.1? BCVA<0.3, BCVA?0.3 in 1 eye, respectively. The non-contact intraocular pressure were normal(the normal intraocular pressure range from 11 mm Hg to 21 mm Hg). All patients accepted treatment after informed, operated pars plana vitrectomy(PPV). According to preoperative intervention methods, the patients were divided into two groups. Group A(21 cases, 23 eyes) received an intravitreal conbercept injection in 3-16 days(average 6.87±3.81 days) before vitrectomy. Group B(18 cases, 18 eyes), refused to the intravitreal conbercept injection. We observed the circumstances of electrocautery in severe bleeding, iatrogenic retinal breaks, endotamponade with silicone oil, reoperation after vitreous hemorrhage, and the best corrected visual acuity of preoperative and postoperative between two groups.Results: In group A, iatrogenicretinal breaks existed in 1 eyes(4.3%) and 6 eyes(33.3%) in group B. There was significantly different between two groups(P<0.05). The events of electrocautery in severe bleeding were 3 eyes(13.0%) in group A and 8 eyes(44.4%) in group B. The statistically significant difference was found between two groups(P<0.05). The intraoperative hemorrhage of angiogenesis occurred in12 eyes of group A vs 18 eyes of group B, endotamponade with silicone oil was performed in 18 eyes(78.3%) of group A vs 12eyes(66.7%) of group B. No statistically significant difference was found between two groups(P>0.05). There was no PPV reoperation after retinal redetachment occurred in group A. In group B, 2 eyes(11.1%) occured in reoperation after retinal redetachment. The averages of preoperative visual acuity and postoperative visual acuity were different in group A(P<0.05) and not significantly different in group B(P>0.05).Conclusion: Preoperative intravitreal injection of conbercept can reduce the occurrence rates of intraoperative severe bleeding, iatrogenic retinal breaks and the using of electrocautery, which are benefit for the improvement of visual acuity in proliferative diabetic retinopathy.