| Objective:To investigate the effect of transpars plana vitrectomy(PPV)with or without preoperativeintravitreal Conbercept injection(IVC)and low molecular weight heparin(LMWH)for the treatment of proliferative diabetic retinopathy(PDR).Methods:295 cases(310 eyes)with proliferative diabetic retinopathy(PDR)were enrolled in our prospective study from December 2013 to October 2017.The patients were randomly divided into three groups:PPV group(A group,control group,101cases,109 eyes),Conbercept and PPV group(B group,115cases,117 eyes),Conbercept+LMWH and PPV group(C group,79cases,84 eyes).B group and C group were treated with intravitreal injection of 0.5 mg Conbercept 5-7 days before vitrectomy.LMWH(1000 IU/L)was added in C group during the vitrectomy.The data of the three groups were compared:best corrcted visual acuity(BCVA),vitrectomy time,intraoperative bleeding,Iatrogenic retinal tear number,silicone oil filling rate,postoperative complications(vitreoushemorrhage,pre-retinal membrane,high intraocular pressure and neovascular glaucoma)and VEGF content after Conbercept intraviraleal injection.Results:1.The general data of thepatients were compared between threegroups:gender,age,duration of diabetes,preoperative BCVA and intraocular pressure(IOP).There was no significant difference between the three groups.2.Among 130 eye with transparent visual media,the retinal neovascularization became thin after 1 day injection and faded 3 days later,the large blood vessels became thin,atrophy with pale appearance.The retina edema decreased.5～7 days later,the neovascularization disappeared and the thinner fibrous proliferation membranes began to contract.Among 71 eyes with obvious vitreous blood,15 eyes(21.1%)absorbed and became thinner.The main complications were subconjunctival hemorrhage(23 eyes in B group,19.7%and 12 eyes in C group,14.3%).The blood absorbed in one month and no special treatment were used.2.56%(3/117 eyes,B group)and 2.38%(2/84 eyes,C group)patients were discoveredhigh intraocular pressure.All were controlled within 30mmHg and were well treated with medicine.4.6%(6/130eyes)patients were discovered pre-retinal membrane without obvious traction retinal hole,hemorrhage and retinal detachment aggravation.There was no other local or systemic complications.3.BCVA:(1)Comparision within the group:ForA group,the average logMAR BCVA of preoperative and 3m,6m,1y,2y after vitrectomy were(1.48±0.49),(0.71±0.25)、(0.53±0.21)、(0.55±0.39)and(0.53±0.28)respectively.ForB group,the average logMAR BCVA of preoperative and 3m,6m,1y,2y after vitrectomy were(1.51±0.44),(0.60±0.23),(0.55±0.27),(0.54±0.22)and(0.55±0.31)respectively.ForC group,the average logMAR BCVA of preoperative and 3m,6m,1y,2y after vitrectomy were(1.46±0.41),(0.58±0.27),(0.54±0.28),(0.53 ±0.24)and(0.54±0.28)respectively.For three groups,The comparison of the 3m,6m,ly,2y logMAR BCVA after surgery with the preoperative logMAR BCVA showed a statistically significant difference respectively.(2)Comparision between the different groups:The comparison of the 6m,ly,2y logMAR BCVA after surgery among the three groups respectively had no statistical significance,while there was statistical significance at 3m after surgery between B、C group and A group.4.Intraoperative observation index:(1)vitrectomy time:The average time for A,B and C group were(138.17±41.22)min,(129.64±47.45)min and(122.77±45.77)min respectively.The comparison of the vitrectomy time among the three groups displayed a statistically significant difference.(2)Iatrogenic retinal tear number:There were 35 eyes(32.1%),21 eyes(17.9%)and 11 eyes(13.1%)Iatrogenic retinal tear respectively for three groups.The comparison of the retinal tear number among the three groups displayed a statistically significant difference.(3)intraoperative bleeding:There were 79 eyes(72.5%),21 eyes(17.9%)and 16 eyes(19.1%)for there groups respectively.There was statistically significant difference between B,C group and A group,while there was no statistically significant difference between B group and C group.(4)silicone oil filling rate:There were 70 eyes(64.2%),54 eyes(46.2%)and 35 eyes(41.7%)for three groups respectively.There was statistically significant difference between B,C group and A group,while there was no statistically significant difference between B group and C group.5.Postoperative complication:(1)The early vitreous hemorrhage:There were 65 eyes(59.6%),30 eyes(25.6%)and 19 eyes(22.6%)for three groups respectively.There was statistically significant difference between B,C group and A group,while there was no statistically significant difference between B and C group.(2)The late vitreous hemorrhage:There were 11 eyes(10.1%),8 eyes(6.8%)and 6 eyes(7.1%)for three groups respectively.There was no statistically significant difference among the three groups.(3)High intraocular pressure and neovascular glaucoma:The number of high intraocular pressure was 11 eyes(10.1%),9 eyes(7.7%)and 9 eyes(10.7%)and the number of neovascular glaucoma was 4 eyes(3.7%),4 eyes(3.4%)and 2 eyes(2.4%)for three groups respectively.There was no statistically significant difference among the three groups.(4)Pre-retinal membrane:There were 34 eyes(31.9%),21 eyes(17.9%)and 12 eyes(14.3%)for three groups respectively.There was statistically significant difference between B,C group and A group,while there was no statistically significant difference between B and C group.6.VEGF content:The average content of VEGF was(765.43±142.29)pg/ml,(326.74±115.20)pg/ml and(298.14±121.25)pg/ml for three groups respectively.There was statistically significant difference between B,C group and A group,while there was no statistically significant difference between B and C group.Conclusions:1.Intravitreal injection Conbercept before vitrectomy is safe and effective.IVC can improve the efficiencysignificantly by shorting surgery time,reducing intraoperative bleeding,iatrogenic retinal tear number and silicone oil filling rate,also decreasing the early postoperative vitreous hemorrhage and pre-retinal membrane.The high intraocular pressure and neovascular glaucom,BCVA and the late postoperative vitreous hemorrhage change mildly.2.LMWH is safe and effective for PDR patients,which can reduce the iatrogenic retinal tear number and shorten the surgery time further by inhibiting the blood clots and fibrous membranes.3.Conbercept play the role by reducing VEGF content in vitreous body. |
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