Vitrectomy combined with preoperative intravitreal ranibizumab improves surgical outcomes in patients with proliferative diabetic retinopathy: a systematic review.

Abstract

Abstract Background. To summarize the current evidence on the effects of vitrectomy combined with preoperative intravitreal ranibizumab (IVR) on proliferative diabetic retinopathy (PDR) and compare surgical outcomes with preoperative no IVR and preoperative intravitreal conbercept (IVC). Methods. The PubMed, Embase, and Cochrane Library databases published until June 2023 were comprehensively searched for studies that compared vitrectomy combined with preoperative IVR and preoperative no IVR or preoperative IVC in patients with PDR. The intraoperative and postoperative outcomes were extracted from the final eligible studies. The mean difference (MD) and odds ratio (OR) were calculated for continuous and dichotomous variables, respectively, with 95% confidence intervals (CIs). Results. A total of 12 studies with 1190 cases (eyes) were included. In the comparison between the IVR group and the no IVR group, the mean surgery time and the rates of endodiathermy, silicone oil tamponade, intraoperative bleeding, and iatrogenic retinal breaks were lower in the IVR group (MD = -22.24, P < 0.00001; OR = 0.24, P < 0.00001; OR = 0.35, P < 0.00001; OR = 0.17, P < 0.0001; OR = 0.23, P < 0.00001). The mean change in best-corrected visual acuity (BCVA) was more significant in the IVR group at one month (MD = − 0.41, P = 0.005) and three months (MD = − 0.16, P = 0.004) postoperatively. Lower incidences of early (≤ 4 weeks) postoperative vitreous hemorrhage (VH) and postoperative neovascular glaucoma (NVG) were associated with the IVR group (OR = 0.36, P < 0.00001; OR = 0.17, P = 0.0001). There was no significant difference between the IVR and IVC groups in mean BCVA improvement or intraoperative and postoperative outcomes. Conclusions. Compared with preoperative no IVR, preoperative IVR not only reduces surgery time, intraoperative electrocoagulation, silicone oil tamponade, intraoperative bleeding, and iatrogenic retinal breaks but also significantly improves early postoperative BCVA and reduces early postoperative VH and postoperative NVG. In addition, preoperative IVR has similar surgical outcomes to preoperative IVC.