Comparative Studies Of Adjunctive Intravitreal Conbercept At Preoperative Or Introperative Of 23G Vitrectomy For Proliferative Diabetic Retinopathy (PDR)

Objective:To observe the therapeutic efficacy of adjunctive intravitreal injection of conbercept at preoperative or intraoperative of 23 G vitrectomy for proliferative diabetic retinopathy(PDR).Methods:A retrospective research was performed on 92 patients(92 eyes)with severe proliferative diabetic retinopathy(PDR)from January 2015 to June 2016 in the Second Affiliated Hospital of Nanchang University who were divided into two groups,according to the condition of the disease and the patients’ will,and received either intravitreal 0.05 ml conbercept injection 3-5 days before 23 G vitrectomy(group A,n=48)or intravitreal 0.05 ml conbercept injection at the end of 23 G vitrectomy(group B,n=44).There were 25 female(25eyes)and 23 male(23eyes)in group A,22 female(22eyes)and 22 male(22eyes)in group B.The form of fibrous proliferative PDR(FPDR),advanced PDR(APDR)without affecting the macular,and advanced PDR(APDR)to involve the macular were 19 cases,17 cases and 12 cases respectively in group A,which were 17 cases,15 cases and 12 cases respectively in group B.The average age was respectively(49.62±9.23)and(53.22±4.43)in group A and B.The operative duration,postoperative best-corrected visual acuity(BCVA),the intraoperative complication(retinal homorrhage and iatrogenic tears),postvitrectomy diabetic vitrerous hemorrhage(PDVH)and postoperative other complication between the two groups were compared.Results:1.Operative duration:⑴The form of FPDR: The average Operative duration of the group were 28.21±2.48 min and 37.53±7.26 min in groups A and B respectively.⑵The form of APDR to involve the macular:The average Operative duration were39.61±3.12 min and 46.46±8.47 min in groups A and B respectively.⑶The form of APDR without affecting the macular:The average Operative duration were33.58±6.38 min and 42.91±7.88 min in groups A and B respectively.The averageoperative time of the three forms in group A were lower than that in group B respectively,and all the comparisons between the two groups showed a statistically significant difference respectively(P<0.05).2.BCVA(LogMAR):⑴ Comparison between groups A and B:(1)The form of FPDR and APDR without affecting the macular: The 1mo,3mo,6mo postoperative BCVA of the group A were higher than the group B.The comparision of the1 mo,3mo,6mo postoperative BCVA between A and B groups had a statistically difference respectively(P<0.05).(2)The form of APDR to involve the macular:The1mo,3mo,6mo postoperative BCVA of the group A were higher than the group B.The comparision of the 1mo,3mo,6mo postoperative BCVA between A and B groups had no significant difference(P>0.05).⑵ Comparison within the group: The1 mo,3mo,6mo postoperative BCVA were lower than the preoperative BCVA respectively in the three forms of the group A and B.(1)In group A: This comparision of the 1mo,3mo,6mo postoperative BCVA between the preoperative BCVA respectively all had no significant difference(P>0.05)in the form of FPDR and APDR to involve the macular,however,which showed a statistically significant difference(P<0.05)in the form of APDR without affecting the macular.(2)In group B:The comparision of the 1mo,3mo,6mo postoperative BCVA between the preoperative BCVA respectively showed no significant difference(P>0.05)in the form of APDR to involve the macular,however,which all showed a statistically significant difference(P<0.05)in the form of FPDR and APDR without affecting the macular respectively.3.Intraoperative iatrogenic tears and retinal homorrhage: The rate of intraoperative iatrogenic tears and retinal homorrhage of the group A were lower than the group B in the three forms.The comparision of the rate of intraoperative iatrogenic tears and retinal homorrhage between groups A and B all showed no significant difference(P>0.05)in the form of FPDR,but which all had a statistically significant difference(P<0.05)in the form of APDR involving or not the macular respectively.4.PDVH: The incidence of early PDVH(≤1month)of the group A were lower than the group B in the three forms.The comparision of the incidence of earlyPDVH(≤1month)between two groups was not statistically significant difference(P>0.05)in the form of FPDR and APDR involving or not the macular respectively.Bsides,the rate of late PDVH(>1month)of the group A were higher than the group B in the three forms.The comparision of the rate of late PDVH(>1month)between two groups showed a statistically significant difference(P<0.05)in the three forms respectively.5.Others: The percentages of reoperation were 6.3%(3 eyes severe PDVH)and4.5%(2 eyes postoperativ TRD)respectively in groups A and B,which comparision had no significant difference(P>0.05).Conclusions:The adjunctive intravitreal injection of conbercept in the end of 23 G vitrectomy,improving the postoperative BCVA of the form FPDR and APDR without involving macular,can prevent effectively early-late priod correlation postvitrectomy diabetic vitrerous hemorrhage(PDVH)for proliferative diabetic retinopathy(PDR).As well as23 G vitrectomy asisted with preoperative intravitreal conbercept can decrease the operation time,the intraoperative complications and the incidences of early(≤1month)postvitrectomy diabetic vitrerous hemorrhage(PDVH).