The Effect of Intravitreal Ranibizumab on Intraoperative Bleeding During Pars Plana Vitrectomy for Diabetic Traction Retinal Detachment

Abstract

Purpose: : To investigate the effects of intravitreal ranibizumab (IVR) on intraocular bleeding during 23-gauge pars plana vitrectomy (PPV) for macula-involving traction retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR).

Methods: : Prospective, double-masked study of 18 consecutive patients with PDR scheduled to undergo PPV for macula-involving TRD of up to three months duration. Patients were randomly assigned to administration of either 0.5 mg IVR (RANI/PPV group; n=9) or sham injection (PPV group; n=9) one week before PPV. All patients completed 12 weeks follow-up after PPV. The main outcome measure was intraocular bleeding during PPV measured by erythrocyte count in the fluid used during surgery (ACCURUS® Surgical System fluid set).

Results: : No statistically significant difference was found between the groups with respect to age, diabetes type and duration, and presence of previous panretinal photocoagulation. Mean ± SE erythrocyte count (*106 cells) was 63.2 ± 25.2 in the RANI/PPV group compared to 185.1 ± 49.2 in the PPV group (p=0.0192; Wilcoxon). There was no within-group statistically significant BCVA change in the RANI/PPV group, but a 0.35 ± 0.1 logMAR BCVA improvement (p<0.05) was observed in the PPV group 12 weeks after surgery.

Conclusions: : IVR was associated with reduced intraocular bleeding during PPV in eyes with macula-involving TRD secondary to PDR, which may contribute to a safer and technically easier surgery. Further study in a larger number of patients is warranted to investigate whether preoperative IVR affects visual function in the long-term.

Clinical Trial: : http://www.clinicaltrials.gov NCT01201161

Keywords: vitreoretinal surgery • diabetic retinopathy • retinal neovascularization