Therapeutic effect and safety of 23G pars plana vitrectomy assisted by ranibizumab for severe proliferative diabetic retinopathy

Background Pars plana vitrectomy (PPV) is a main method of treating severe proliferative diabetic retinopathy (PDR), but intraoperative bleeding often occurs, which affects the intraoperative process and final prognosis.Intravitreal injection of ranibizumab (IVR), a vascular endothelial growth factor (VEGF) monoclonal antibody, has been used in PPV, so the evaluation of therapeutic effect and safety of PPV associated by IVR is very important. Objective This study was to evaluate the effect of IVR-assisted 23G PPV on patients with severe PDR. Methods The clinical data of 82 eyes of 77 patients with severe PDR who received 23G PPV from August 2012 to December 2013 were respectively analyzed, including 49 eyes undergone IVR-assisted 23G PPV (IVR combined with PPV group) and 33 eyes undergone 23G PPV only (simple PPV group). IVR (0.5 mg/0.05 ml) was performed on the eyes 5-7 days before PPV in the IVR combined with PPV group, and only PPV was carried out in the simple PPV group.Operative duration, endodiathermy times, incidence of iatrogenic retinal holes, best corrected visual acuity (BCVA)(LogMAR), postoperative bleeding, re-operation rate, Ⅰphase attached rate of retinas, occurrence rate of neovascular glaucoma and temporary ocular hypertension rate were compared between the two groups. Results The average operation duration was (71.90±26.42) minutes in the IVR combined with PPV group, which was significantly shorter than (96.76±25.15) minutes in the simple PPV group (t=-4.300, P 0.05). Conclusions IVR before 23G PPV can reduce the risk of intravitreal bleeding during operation and after surgery, shorten operation duration and lessen the incidence of iatrogenic retinal break.The BCVA after IVR-assisted PPV improves as good as simple PPV. Key words: Antibodies, monoclonal, humanized/administration; Intravitreal injection; Diabetic retinopathy/surgery; Vitrectomy; Treatment outcome; Postoperative complications; Retrospective studies; Ranibizumab