Meta-analysis of long-term efficacy of vitrectomy combined with anti-VEGF in the treatment of proliferative diabetic retinopathy

Abstract

AIM: To explore the long-term efficacy of vitrectomy combined with or without anti-VEGF in the treatment of proliferative diabetic retinopathy(PDR).METHODS: Randomized controlled trials(RCTs)comparing the efficacy of vitrectomy combined with or without anti-VEGF therapy for PDR were retrieved from databases including PUBMED, EMBASE, Cochrane Central Register of Controlled Trials(CENTRAL)and Web of Science. The retrieval time was from the establishment of the databases to July 2020. According to the inclusion and exclusion criteria, the literature was selected, then data extraction and quality evaluation was completed. Primary evaluation measures included postoperative incidence of retinal detachment, central retinal thickness(CRT), and best corrected visual acuity(BCVA). RESULTS: In this article, 11 randomized controlled studies(880 eyes)were included. Meta-analysis results showed that the incidence of retinal detachment after vitrectomy was significantly lower in PDR patients who received anti-VEGF injection before vitrectomy than in patients who did not receive anti-VEGF injection [Risk ratio(RR)=0.39, 95% Confidence interval(CI)0.22 to 0.71, P=0.002]. There were significant differences in the incidence of retinal detachment after vitrectomy between the anti-VEGF group and the non-VEFG group in both Asian and non-Asian populations(Asian: RR=0.20, 95%CI 0.05 to 0.87, P=0.03; Non-Asian: RR=0.46, 95%CI 0.24 to 0.89, P=0.02). The central retinal thickness of PDR patients who received preoperative anti-VEGF therapy was significantly lower than that of patients who did not receive anti-VEGF therapy 3 and 6mo after PPV(MD=-78.49, 95%CI -94.81 to -62.17, P<0.00001. MD= -39.62, 95%CI -48.44 to -30.80, P<0.00001). The BCVA at 6mo after PPV in PDR patients with preoperative anti-VEGF treatment was better than that in patients without preoperative anti-VEGF treatment(MD=-0.16, 95%CI -0.21 to -0.10, P<0.00001).CONCLUSION: Anti-VEGF injection before PPV can effectively reduce the incidence of retinal detachment, alleviate postoperative macular edema, reduce the central retinal thickness, and improve BCVA in PDR patients.

Keywords

• anti-vegf
• vitrectomy
• proliferative diabetic retinopathy
• retinal detachment
• central retinal thickness
• best corrected visual acuity