Perioperative anti-vascular endothelial growth factor agents treatment in patients undergoing vitrectomy for complicated proliferative diabetic retinopathy: a network meta-analysis

Abstract

Currently, controversies regarding the optimal time-point of anti-vascular endothelial growth factor (VEGF) pretreatment before pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) still exist. To clarify this, we conducted a network meta-analysis, 26 randomized controlled trials including 1806 PDR patients were included. Compared with the sham group, performing anti-VEGF injection at preoperative (Pre-Op) 6 to 14 days could significantly improve post-operative best-corrected visual acuity (BCVA) and decrease the incidence of recurrent vitreous hemorrhage (VH). Meanwhile, it could significantly reduce the duration of surgery. Performing anti-VEGF injection at Pre-Op more than 14 days, 6 to 14 days or 1 to 5 days could significantly reduce the incidence of intra-operative bleeding, while no significant benefit existed at the end of PPV (P > 0.05). No significant difference existed between all those strategies and sham group in reducing the rate of silicone oil tamponade. Based on currently available evidence, performing the anti-VEGF pretreatment at pre-operative 6 to 14 days showed best efficacy in improving post-operative BCVA, reducing the duration of surgery and incidence of recurrent VH, it also achieves satisfactory effect in reducing the incidence of intra-operative bleeding.

Anti-Vascular Endothelial Growth Factor Therapy as an Adjunct to Diabetic Vitrectomy

“…Vascular Endothelial Growth Factor (VEGF) is a regulator of angiogenesis and vascular permeability and plays a key role in the pathogenesis of diabetic retinopathy and other vascular diseases of the retina [9,21]. Vascular endothelial growth factor inhibitors (anti-VEGF agents) have been successfully used in ophthalmology for the regression of neovascularization and reduction of macular oedema, particularly in the treatment of intraocular haemorrhages, neovascular glaucoma and macular oedema in PDR [10,22].…”

“…Vascular endothelial growth factor inhibitors (anti-VEGF), such as ranibizumab, bevacizumab, and aflibercept, are commonly used in ophthalmology to treat macular oedema and intraocular neovascularization [9,10]. There are many reports in the medical literature on the successful use of anti-VEGF agents to reduce the incidence of intra-and postoperative complications during vitrectomy in patients with PDR.…”

Pharmacotherapy as an adjunct to vitrectomy

“…In fact, a recent meta-analysis supports these findings. 16 The study compared the efficacy of the different perioperative time-points of anti-VEGF administration reported in the literature. They concluded that administration 6–14 days prior to pars plana vitrectomy showed the best efficacy in improving visual acuity and reducing incidence of recurrent vitreous hemorrhage since this interval allows significant regression of neovascularization.…”

Role of Vitrectomy in the Treatment of Diabetic Retinopathy

“…в 2020 году провели метаанализ 26 рандомизированных контролируемых испытаний, включающих 1806 пациентов с ПДР. По результатам исследования использование анти-VEGF-терапии за 6-14 дней перед витрэктомией для лечения осложнений ПДР может значительно улучшить послеоперационную остроту зрения, сократить продолжительность операции и снизить частоту рецидивирующего гемофтальма, а также дает удовлетворительный эффект в отношении снижения интраоперационного кровотечения [33].…”