Intravitreal recombinant tPA before vitrectomy for diabetic tractional retinal detachment: A randomized controlled trial

Falavarjani, Khalil Ghasemi; Anvari, Pasha; Shad, Esrafil; Niri, Mohammad Hasan Dehghan; Sedaghat, Ahad; Abdi, Fatemeh; Parvaresh, Mohammad Mehdi; Saeidian, Behrouz; Gordiz, Arzhang; Amirfarhangi, Abdollah

doi:10.1177/11206721221116013

Cited by 2 publications

(2 citation statements)

References 33 publications

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“…The authors speculated that the possible reasons for failure could be the variability of the action of t-PA, conditional response on the presence of plasminogen, insufficient t-PA dose, and short time interval between the injection and surgery (8) . Recently, Falavarjani et al showed that t-PA injection 5-7 days before surgery is beneficial in decreasing the number of iatrogenic retinal break formations and surgery time in cases with diabetic tractional retinal detachment (11) .…”

Section: Discussionmentioning

confidence: 99%

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Preoperative co-application of bevacizumab and tissue plasminogen activator in vitrectomy for proliferative diabetic retinopathy

Aras,

Senturk,

Erdur

et al. 2024

ABO

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To investigate the clinical benefits of the co-application of bevacizumab and tissue plasminogen activator as adjuncts in the surgical treatment of proliferative diabetic retinopathy. Methods: Patients who underwent vitrectomy for proliferative dia betic retinopathy complications were preoperatively given in travitreal injection with either bevacizumab and tissue plasminogen activator (Group 1) or bevacizumab alone (Group 2). Primary outcomes were surgery time and number of intraoperative iatrogenic retinal breaks. Secondary outcomes included changes in the best-corrected visual acuity and postoperative complications at 3 months postoperatively. Results: The mean surgery time in Group 1 (52.95 ± 5.90 min) was significantly shorter than that in Group 2 (79.61 ± 12.63 min) (p<0.001). The mean number of iatrogenic retinal breaks was 0.50 ± 0.59 (0-2) in Group 1 and 2.00 ± 0.83 (0-3) in Group 2 (p<0.001). The best-corrected visual acuity significantly improved in both groups (p<0.001). One eye in each group developed retinal detachment. Conclusion: Preoperative co-application of bevacizumab and tissue plasminogen activator as adjuncts in the surgical treatment of proliferative diabetic retinopathy shortens the surgery time and reduces the number of intraoperative iatrogenic retinal breaks.

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Section: Discussionmentioning

confidence: 99%

“…In addition, we used 50 µg of t-PA, which was greater than the 25 µg used in previous studies, to generate more plasmin. Falavarjani et al also used 50 µg of t-PA and injected t-PA 5-7 days preoperatively (11) .…”

Section: Discussionmentioning

confidence: 99%

Preoperative co-application of bevacizumab and tissue plasminogen activator in vitrectomy for proliferative diabetic retinopathy

Aras,

Senturk,

Erdur

et al. 2024

ABO

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Elucidating postoperative dynamics in tractional retinal detachment: a systematic review and meta-analysis of structural and functional outcomes following diabetic vitrectomy, including an analysis of postoperative complications

Quiroz-Reyes,

Quiroz-Gonzalez,

Quiroz-Gonzalez

et al. 2024

BMC Ophthalmol

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This meta-analysis aims to evaluate the efficacy and safety of diabetic vitrectomy for treating tractional retinal detachment (TRD) by assessing visual acuity improvements, retinal reattachment success rates, and the frequency of postoperative complications. A comprehensive literature search identified 1,211 studies, 30 of which met the inclusion criteria and were analyzed. The meta-analyses were conducted via random effects models to account for heterogeneity. The primary outcomes were visual acuity improvement and retinal reattachment success, whereas postoperative complications were analyzed as secondary outcomes. Funnel plots, trim-and-fill methods, and Egger’s regression tests were employed to assess and adjust for publication bias. The meta-analysis included data from 1,844 eyes across 30 studies. The pooled mean difference (MD) in visual acuity following diabetic vitrectomy was 0.80 logMAR (95% CI: 0.58–1.01, p < 0.0001), with significant heterogeneity (I² = 95%). The trim-and-fill method adjusted the MD to 1.15 (95% CI: 0.85–1.45), indicating potential publication bias. The pooled proportion of retinal reattachment success was 94.63% (95% CI: 90.88–96.89%), with substantial heterogeneity (I² = 82.2%). Egger’s regression test confirmed publication bias in the retinal reattachment data (t = 6.07, df = 25, p < 0.0001). The most common postoperative complications were vitreous hemorrhage (8.2%, 0–41%), elevated intraocular pressure (7.3%, 0–25%), and cataract formation (10.3%, 0–43%). Diabetic vitrectomy significantly improves visual acuity and achieves high retinal reattachment success rates in patients with TRD despite considerable heterogeneity across studies. However, a critical limitation of the current literature is the lack of comprehensive reporting of essential markers of perfusion, such as the choroidal vascularity index and choriocapillaris flow area, which are crucial for a thorough understanding of the impact of vitrectomy on ocular perfusion and its correlation with structural and functional outcomes. These findings also highlight the need for vigilant postoperative management to mitigate common complications. Adjustments for publication bias via the trim-and-fill method suggest that the initial estimates of efficacy may be optimistic, but the overall benefits of the procedure remain substantial. Further research is warranted to standardize surgical techniques, include detailed perfusion outcomes, and enhance the reliability of future meta-analyses. Trial registration: Retrospectively registered.

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Intravitreal recombinant tPA before vitrectomy for diabetic tractional retinal detachment: A randomized controlled trial

Cited by 2 publications

References 33 publications

Preoperative co-application of bevacizumab and tissue plasminogen activator in vitrectomy for proliferative diabetic retinopathy

Preoperative co-application of bevacizumab and tissue plasminogen activator in vitrectomy for proliferative diabetic retinopathy

Elucidating postoperative dynamics in tractional retinal detachment: a systematic review and meta-analysis of structural and functional outcomes following diabetic vitrectomy, including an analysis of postoperative complications

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