Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy: a meta-analysis of randomised controlled trials

Abstract

Background/aimsTo evaluate the efficacy of antivascular endothelial growth factor (anti-VEGF) agents pretreatment before vitrectomy for patients with complicated proliferative diabetic retinopathy (PDR).MethodsThe PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched up to June 2017 to identify related studies. The Peferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. The StataSE V.12.0 software was used to analyse the relevant data. The weighted mean difference, relative risk and their 95% CIs were used to assess the strength of the association.Results14 randomised controlled trials involving 613 patients were assessed, the anti-VEGF pretreatment group included 289 patients and the control group included 324 patients. Our analysis indicated that anti-VEGF pretreatment before vitrectomy for complicated PDR could facilitate much easier surgery regarding less intraoperative bleeding, less endodiathermy, shorter duration of surgery, less iatrogenic retinal breaks, less frequency of using silicone oil and relaxing retinotomy (P<0.05). Additionally, anti-VEGF pretreatment could also achieve better postoperative best-corrected visual acuity, less early recurrent vitreous haemorrhage (VH) and quicker absorption of recurrent VH (P<0.05). However, the incidence of late recurrent VH, recurrent retinal detachment or related secondary surgery could not be reduced (P>0.05).ConclusionThe pretreatment of anti-VEGF agents before vitrectomy for patients with complicated PDR might facilitate much easier surgery and better visual rehabilitation, reduce the rate of early recurrent VH and accelerate its absorption. Moreover, future better-designed studies with larger sample sizes are required to further evaluate the efficacy of different anti-VEGF agents and reach a firmer conclusion.

Prognostic factors of revitrectomy for complications in eyes with proliferative diabetic retinopathy: a retrospective multicentre study

“…This can firstly be due to the fact that in our study, revitrectomy was performed when postoperative VH persisted for a minimum of 1 month after the initial vitrectomy, not for early postoperative VH. Zhao reported in the randomized control study that anti‐VEGF injection provides complete VEGF blockage for about 4 weeks (Zhao et al ). In the present study, we performed anti‐VEGF injection or additional PRP at first when recurrent of postoperative VH, and revitrectomy was performed for eyes with recurrence of VH not anti‐VEGF effective.…”

Outcome of Vitrectomy in Proliferative Diabetic Retinopathy Patients with Diabetic Nephropathy- A Retrospective Study at Tertiary Eye Centre, Telangana State, in South India

“…Ranibizumab is a humanized monoclonal antibody fragment, which lacks an Fc domain, that functions by blocking all VEGF-A isoforms. 8 Two groups were compared to see the outcome. According to some authors the use of anti VEGF agents there is no role in the outcome of vitrectomy in PDR cases 9 .…”

Perioperative anti-vascular endothelial growth factor agents treatment in patients undergoing vitrectomy for complicated proliferative diabetic retinopathy: a network meta-analysis

“…Pars plana vitrectomy (PPV) combined with anti-vascular endothelial growth factor (VEGF) agents injections had been widely accepted to be the standard management for PDR patients complicated with VH or TRD 5 , 6 . Our previous meta-analysis 2 had confirmed the pretreatment of anti-VEGF agents before vitrectomy for patients with complicated PDR might achieve much smoother surgery and better visual rehabilitation, reduce the rate of early recurrent VH and accelerate its absorption.…”

“…Despite the understanding and management of diabetes had evolved tremendously over the last decades, diabetic retinopathy (DR) is still one of the leading causes of legally blind and responsible for up to 4.8% of blindness globally 1 . Proliferative diabetic retinopathy (PDR) is the worst stage of DR and always complicated with vitreous hemorrhage (VH) and even tractional retinal detachment (TRD) 2 . These complications are major causes of severe visual damage in PDR patients and need timely surgical interventions 3 , 4 .…”