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• W2308114639 abstract "Proliferative diabetic retinopathy (PDR) is a major cause of visual loss in patients with diabetes worldwide (Aiello et al. 1998). Despite adequate panretinal photocoagulation (PRP), nearly 4.5% of the eyes may require pars plana vitrectomy (PPV) for PDR, such as non-clearing and recurrent vitreous haemorrhage and tractional retinal detachment (TRD) (Flynn et al. 1992). Our meta-analysis revealed that intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) before vitrectomy for PDR can reduce intra-operative bleeding and the frequency of endodiathermy as well as shorten the mean surgical times. These injections can also shorten the time for reabsorption of blood after vitrectomy, decrease the incidence of recurrent postoperative vitreous haemorrhage (VH) and improve best-corrected visual acuity (BCVA) (Zhang et al. 2013). However, there are no reports about the effect of preoperative intravitreal injections of VEGF medications such as ranibizumab or bevacizumab on postoperative neovascular glaucoma (NVG) for PPV. We commenced this retrospective study to evaluate the effect of preoperative intravitreal injections of ranibizumab (IVR) on postoperative NVG in patients with severe PDR undergoing vitrectomy. Consecutive diabetic patients enrolled between May 2011 and May 2014 were included if they had PDR-related complications, such as persistent vitreous haemorrhage for more than 1 month and no history of PRP, non-clearing vitreous haemorrhage with a history of complete PRP, VH with iris neovascularization (INV), VH with retinal detachment according to B-scan ultrasonography and macula-involving or macula-threatening TRD. The patients who received IVR before PPV were assigned to group A, and the patients who underwent PPV without receiving IVR (0.5 mg) were assigned to group B. All patients in group A underwent PPV within 5–7 days of IVR. All eyes had a minimum of 12 months of postoperative follow-up. Demographic data and both intra-operative and postoperative findings were recorded (Table 1). We discovered that postoperative BCVA was better in group A than in group B (logMAR units: 0.427 ± 0.43 versus 0.691 ± 0.59, p < 0.05). Similarly, there were significant differences in improved BCVA (91.5% versus 71.1%; p < 0.05), unchanged BCVA (5.1% versus 15.5%; p < 0.05) and worse BCVA (3.4% versus 13.4%; p < 0.05) between groups A and B. Postoperative early VH occurred significantly less frequently in group A (eight of 59 eyes, 13.6%) than in group B (32 of 97 eyes, 33.0%; p < 0.01). Importantly, the incidence of postoperative NVG in group A was significantly less than that in group B (1.7% versus 12.4%; p < 0.05) (Table 1). In the present study, our results demonstrated that pretreatment by IVR in eyes with severe PDR before vitrectomy reduced postoperative early vitreous cavity haemorrhage and improved BCVA. Importantly, our results indicated that the incidence of postoperative NVG in patients with severe PDR treated by preoperative IVR was remarkably less than the corresponding incidence in patients without preoperative IVR. Ranibizumab (Lucentis, Novartis Pharma AG, Switzerland) is a novel agent that selectively inhibits active isoforms of human vascular endothelial growth factor A (VEGF-A) from binding to its receptors (Bressler et al. 2013). IVR is widely used for neovascular complications of PDR (Nicholson & Schachat 2010; Montero et al. 2011); specially, it has become popular as a preoperative adjunct in cases of severe PDR. It helps with rapid clearing of VH and reduces surgical times by reducing intra-operative bleeding. In summary, preoperative IVR for patients with severe PDR contributes to a decreased risk of postoperative NVG, suggesting that preoperative IVR radically improves surgical prognoses in patients with severe PDR." @default.
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• W2308114639 date "2016-03-24" @default.
• W2308114639 modified "2023-09-22" @default.
• W2308114639 title "Preoperative intravitreal injection of ranibizumab for patients with severe proliferative diabetic retinopathy contributes to a decreased risk of postoperative neovascular glaucoma" @default.
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• W2308114639 doi "https://doi.org/10.1111/aos.13019" @default.
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