| Objective: To observe the therapeutic efficacy of the intravitreal injection of anti-VEGF drugs(including ranibizumab and combosil),panretinal photocoagulation(PRP)and the combination of both with the aid of 23 G Pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR).Methods: Retrospective clinical controlled studies.From January 2016 to March 2017,110 patients 110 eyes(Binocular PDR patients choose surgical eye according to the actual situation)who underwent 23 G vitrectomy for PDR in the ophthalmic department of the Second Affiliated Hospital of Nanchang University were included in the study.In group A,PPV preoperative intravitreal injection of antiVEGF drugs(Ranibizumab or combosibide 0.05ml)26 patients 26 eyes.Group B: PPV patients were preoperatively performed in 28 patients with 28 eyes.Group C: PPV intravitreal injection of anti-VEGF drugs(Ranibizumab or combosibide 0.05ml)and PRP patients 27 patients 27 eyes.Group D: 29 cases of 29 cases of PPV without intravitreal injection of anti-VEGF drugs and PRP before PPV.Comparison of PPV intraoperative complications(bleeding volume,iatrogenic retinal holes,silicone oil filling rate,electrocoagulation),postoperative best-corrected visual acuity(BCVA)and intraocular pressure(IOP),postvitrectomy diabetic vitreous hemorrhage(PDVH)and other complications in four groups of patients.Note: Patients in Group A and Group C have previously received PDR treatment and have been treated with PRP based on fundus fluorescein angiography(FFA).Result:1.After 1 month,the mean BCVA of the four groups were 1.11±0.26,1.28±0.26,1.06±0.34,1.46±0.38,and the mean BCVA at 6 month after surgery were 0.82±0.12,1.10±0.22,0.81±0.12,and 1.13±0.25,respectively.There was a statistically significant difference in visual acuity between the four groups after 1 month of surgery and after 6 month of surgery(p<0.05).The average postoperative BCVA in all groups A,B,C,and D was increased to different degrees before surgery,showing an upward trend with statistically significant differences(p<0.05).At 1 month after surgery,the mean BCVA was higher in group A,B,and C than in group D,and the difference in visual acuity was statistically significant(p<0.05).At 6 month after surgery,there was no significant difference in mean BCVA between groups B and D(p>0.05).At 6 month after surgery,there was no significant difference in mean BCVA between groups A and C(p>0.05),but the mean BCVA was higher in group A and group C than in group D,with statistically significant difference(p<0.05).2.The number of eyes with electrocoagulation in the four groups was 4,9,3,and 12 eyes respectively.The statistical analysis of the electrocoagulation rates among the four groups was statistically significant(p<0.05).The number of eyes filled with silicone oil was 4,10,4 and 14 eyes,respectively.Statistical analysis was performed on the silicone oil filling rate between the groups(p<0.05);iatrogenic retinal breaks occurred in the four groups.There was no statistically significant difference between the eye groups with severe bleeding during surgery(p>0.05).3.The number of rebleeding eyes in the early vitreous(≤1 month)in the four groups was 2,2,2 and 10 eyes respectively,statistical analysis was performed on the early bleeding rate between groups.The difference was not statistically significant(p<0.0167).The number of rebleeding eyes in the early vitreous(≤1 month)in the three groups of patients A,B and C was lower than that in group D,with statistically significant differences(all p<0.05).The number of rebleeding eyes in the late vitreous(>1 month)in the four groups was 1,1,1 and 2 eyes respectively.The statistical analysis of the late bleeding rate among the groups showed no significant difference(p>0.05).Conclusion: Preoperative anti-VEGF,PRP-assisted 23 G minimally invasive vitrectomy for PDR can reduce intraoperative complications,reduce the rate of early postoperative vitreous rebleeding,and effectively improve the visual function. |
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