23-G vitrectomy assisted with intravitreal injection of ranibizumab in the treatment of proliferative diabetic retinopathy

Objective To observe the therapeutic efficacy of 23-G vitrectomy assisted with intravitreaI injection of ranibizumab (IVR) in the treatment of proliferative diabetic retinopathy (PDR). Methods A prospective, randomized, and comparative case series study. A total of 80 patients (80 eyes) with PDR were recruited to have 23-G vitrectomy with (combined group) or without (pure PPV group) IVR. There were 40 eyes in the combined group and 40 eyes in the pure PPV group. The average operation time, iatrogenic breaks, electric coagulation, postoperative bleeding and best corrected visual acuity were comparatively analyzed among the two groups. The follow-up time was 8.0 months. Results The average operation time was 44.5±10.6 mins in the combined group and 59.4±12.5 mins in the pure PPV group. The rate of iatrogenic breaks and electric coagulation in the combined group were significantly decreased compared with pure PPV group (P=0.029, 0.003). The postoperative logMAR BCVA was 1.06±0.21 in the combined group and 1.36±0.32 in the pure PPV group, which significantly improved postoperatively (P=0.015, 0.045). The postoperative logMAR BCVA in the combined group was better than in the pure PPV group (P=0.033). The incidence of the recurrent vitreous hemorrhage, anterior chamber hemorrhage, Neovascular glaucoma in the combined group was less than in the pure PPV group (P=0.001, 0.006, 0.037). There was no severe complication associated with surgery, such as choroidal detachment, retinal detachment and endophthalmitis. Conclusions 23-G vitrectomy assisted with intravitreal injection of ranibizumab can shorten the operation time, reduce the use of electric coagulation and iatrogenic breaks, improve visual acuity for PDR patients. Key words: 23-G vitrectomy; Intravitreal injection of ranibizumab; Proliferative diabetic retinopathy