Prospective Comparison of Surgery Outcome Between Preoperative and Intraoperative Intravitreal Injection of Ranibizumab for Vitrectomy in Proliferative Diabetic Retinopathy Patients

Abstract

Introduction: To compare the efficacy and safety of intravitreal injections of ranibizumab (IVR) before and at the end of vitrectomy in proliferative diabetic retinopathy (PDR) patients.

Methods: A prospective comparative study was performed on 60 eyes of 52 PDR patients who received ranibizumab injection (0.5 mg/0.05 ml) 3-5 days before vitrectomy (preoperative group) and 55 eyes of 50 PDR patients who received ranibizumab injection (0.5 mg/0.05 ml) at the end of vitrectomy (intraoperative group). Intra- and postoperative indices were collected for further comparison.

Results: Postoperative best-corrected visual acuity (BCVA) in preoperative group was better than in intraoperative group at 1 week after surgery (P < 0.05) but comparable at 1- and 3-month follow-up (P = 0.20 and P = 0.37, respectively). Central retinal thickness (CRT) in preoperative group was lower than in intraoperative group at 1 week postoperatively (P < 0.05), but comparable at 1- and 3-month follow-up (P = 0.39 and P = 0.77, respectively). The average surgery time was significantly shorter in preoperative group than in intraoperative group (61.50 ± 11.44 min vs. 74.49 ± 12.01 min, P < 0.01). The incidence of intraoperative bleeding was significant lower in preoperative group than in intraoperative group (21.7% vs. 40.0%, P < 0.05). Moreover, the incidence of intraocular electrocoagulation use, iatrogenic retinal breaks, relaxing retinotomy and silicone oil tamponade were all significantly lower in preoperative group than that in intraoperative group (P < 0.05, respectively). The incidences of postoperative vitreous hemorrhage (VH), neovascular glaucoma (NVG), recurrent retinal detachment, postoperative fibrovascular proliferation progression and reoperation showed no statistical differences between the two groups (P > 0.05, respectively). Both groups had no ocular or system adverse events during observation period.

Conclusion: In vitrectomy for PDR, preoperative IVR can significantly reduce surgery time and lower the incidence of intraoperative bleeding, intraocular electrocoagulation use, iatrogenic retinal breaks, relaxing retinotomy and silicone oil tamponade during surgery and gain short-term better postoperative BCVA and thinner CRT.

Trial registration: ClinicalTrials.gov (identifier, NCT05408416).

Keywords: Intraoperative intravitreal injection; Pars plana vitrectomy; Preoperative intravitreal injection; Proliferative diabetic retinopathy; Ranibizumab.

© 2022. The Author(s).

Figures

Fig. 1

Flowchart showing the distribution of the study population. PPV pars plana vitrectomy

Fig. 2

BCVA at each visit during 3-month follow-up between two groups. BCVA best-corrected visual acuity; Log MAR logarithm of minimal angle of resolution

Fig. 3

CRT at each visit during 3-month follow-up between two groups. CRT, central retinal thickness

Fig. 4

A 58-year-old woman underwent PPV for significant vitreous hemorrhage (A and E). Recurrent bleeding occurred 1 week after surgery (B and F). VH was significantly absorbed at 1 month (C) and parafovea retinal edema was observed too (G). VH was completely absorbed at 3 month (D), and PRP was clearly visible. The parafovea retinal edema was stable (H)

Fig. 5

A 45-year-old male who had underwent incomplete PRP was prepared for PPV for diffuse FP (A) with hard exudation at parafovea (E). Supplemented intraoperative laser photocoagulation (B) and hard exudation at parafovea (F) can be observed at 1 week’s fundus and OCT images. Retinal patchy hemorrhage disappeared (C), and hard exudation was further absorbed (G) 1 month after surgery. At the 3rd month, the fundus was stable (D) with a good fovea structure (H)