| Research Basics Diabetic retinopathy(DR) is one of the serious complications of diabetes, proliferative diabetic retinopathy(PDR) is the advanced stage of DR, characterized by vitreous hemorrhage and tractional retinal detachment, seriously affect the vision and even lead to blindness. PDR eyes with severe ischemia can cause iris neovascularization(INV). These neovascularization distributed in the surface of iris obstruct trabecular meshwork, lead to peripheral iris adhesion and angle closure, further caused intraocular pressure elevation, while ocular ischemia hypoxia and high intraocular pressure affect the retinal and optic nerve function, which lead to serious visual impairment. In the pathogenesis of iris neovascularization, VEGF is the key cytokines of neovascularization. PDR eyes once appeared iris neovascularization, no longer treated with vitrectomy surgery for visual restored before, only took conservative treatment such as controlling intraocular pressure. Recently, VEGF inhibitors such as ranibizumab in the treatment of neovascular eye disease made significant effect. VEGF inhibitors as an adjunct before vitrectomy surgery in the treatment of PDR achived good surgical results.Objective To observe the intraoperative and postoperative situations of vitrectomy surgery for PDR with INV after intravitreal ranibizumab. To investigate the surgical experience of vitrectomy which combined with ranibizumab in the treatment of PDR with INV.Methods During January 2013 and September 2014,the data of 20 patients(26 eyes) of PDR with INV were retrospectively analyzed. All patients had vitreous hemorrhage and(or) tractional retinal detachment. Vitrectomy with non-contact wide angle lenses was performed 3 to 7 days after intravitreal ranibizumab. The changes of INV, operation time, intraoperative and postoperative conditions were analyzed. Compared preoperative and postoperative intraocular pressure, preoperative and postoperative visual acuity.Result Intravitreal injection of ranibizumab were performed in 20 cases(26 eyes). At 1 day after the intravitreal ranibizumab, INV regressed in 10 eyes(38.46%) obviously, there was no change in 16 eyes(61.54%). At 3 days after the intravitreal ranibizumab, INV regressed in 20 eyes(76.92%) obviously, there was no change in 6 eyes(23.08%). At 7 days after the intravitreal ranibizumab, INV was not changed in 4 eyes(15.38%). Vitrectomy had not been performed in 4 eyes of 4 cases(15.38%).Mean operation time was(71.12±9.53) min of 22 eyes of 20 cases. Intraoperative mild bleeding occurred in 15 eyes(68.18%), moderate bleeding occurred in 5 eyes(22.73%), severe bleeding occurred in 2 eyes(9.09%). During the operation, iatrogenic retinal breaks occurred in 2 eyes(9.09%), tractional retinal breaks occurred in 4 eyes(18.18%). Silicone oil were used in 5 eyes(22.73%), C3F8 was used in 1 eye(4.55%), which retinal breaks appeared. At 1 week after the vitrectomy, vitreous hemorrhage occurred in 3 eyes(13.64%). At 1 month after the vitrectomy, vitreous hemorrhage occurred in 2 eyes(9.09%).At 3 days after injection average intraocular pressure was(23.77±6.79)mm Hg, compared with before injection decreased(3.08±2.04)mm Hg, but the difference was not statistically significant(t=1.827, P=0.080). At 1 week after vitrectomy average intraocular pressure was(23.32±7.97) mm Hg, the difference was not statistically significant compared with before injection(t=1.150, P=0.263). At 1 month, 3 months after vitrectomy average intraocular pressure were(20.95±5.46; 19.86±4.76) mm Hg, the differences were statistically significant compared with before injection(t=2.644, P=0.015; t=4.176, P=0.000). At 3 months after vitrectomy, best corrected visual acuity(BCVA) was improved in 17 eyes(77.27%), remained unchanged in 3 eyes(22.73%) preoperative BCVA were hand movement, in 2 eyes(9.09%) BCVA by finger counting fell to hand movement. Compared BCVA at 1 week, 1 month after the vitrectomy with preoperative, the differences were not statistically significant(χ2=0.346, P=0.556; χ2=3.569, P=0.059). Compared BCVA at 3 months after the vitrectomy with preoperative, the difference was statistically significant(χ2=7.725,P=0.005).Conclusions 1.Intravitreal injection of ranibizumab can make iris neovascularizationis regress obviously. 2.Intravitreal injection of ranibizumab befor vitrectomy can shorten the operation time, reduce the intraoperative complications, had inhibitory effect on postoperative disease progression, can obviously improve the postoperative visual acuity of the PDR patients with INV. 3.Vitrectomy with non-contact wide angle lens was more suitable than traditional corneal contact lens in the treatment of PDR with INV, expand ranges of vitrectomy indication. |
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