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      Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy: a meta-analysis of randomised controlled trials

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          Abstract

          Background/aims

          To evaluate the efficacy of antivascular endothelial growth factor (anti-VEGF) agents pretreatment before vitrectomy for patients with complicated proliferative diabetic retinopathy (PDR).

          Methods

          The PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched up to June 2017 to identify related studies. The Peferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. The StataSE V.12.0 software was used to analyse the relevant data. The weighted mean difference, relative risk and their 95% CIs were used to assess the strength of the association.

          Results

          14 randomised controlled trials involving 613 patients were assessed, the anti-VEGF pretreatment group included 289 patients and the control group included 324 patients. Our analysis indicated that anti-VEGF pretreatment before vitrectomy for complicated PDR could facilitate much easier surgery regarding less intraoperative bleeding, less endodiathermy, shorter duration of surgery, less iatrogenic retinal breaks, less frequency of using silicone oil and relaxing retinotomy (P<0.05). Additionally, anti-VEGF pretreatment could also achieve better postoperative best-corrected visual acuity, less early recurrent vitreous haemorrhage (VH) and quicker absorption of recurrent VH (P<0.05). However, the incidence of late recurrent VH, recurrent retinal detachment or related secondary surgery could not be reduced (P>0.05).

          Conclusion

          The pretreatment of anti-VEGF agents before vitrectomy for patients with complicated PDR might facilitate much easier surgery and better visual rehabilitation, reduce the rate of early recurrent VH and accelerate its absorption. Moreover, future better-designed studies with larger sample sizes are required to further evaluate the efficacy of different anti-VEGF agents and reach a firmer conclusion.

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          Most cited references27

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          The effect of adjunctive intravitreal bevacizumab for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy.

          To assess the effects of preoperative and intraoperative intravitreal bevacizumab (IVB) injection on the incidence of postoperative vitreous hemorrhage (VH) after vitrectomy for proliferative diabetic retinopathy (PDR). Prospective, randomized, clinical trial. One hundred seven eyes of 91 patients undergoing pars plana vitrectomy (PPV) for the management of PDR-related complications were enrolled. One hundred seven cases were assigned randomly to either group 1 (intravitreal 1.25 mg/0.05 ml bevacizumab injection 1 to 14 days before PPV), group 2 (intravitreal 1.25 mg/0.05 ml bevacizumab injection at the end of PPV), or group 3 (no IVB injection). The primary outcome was the incidence of early (≤ 4 weeks) and late (> 4 weeks) recurrent VH. Secondary outcome measures were the initial time of vitreous clearing (ITVC) and best-corrected visual acuity (BCVA) at 6 months after surgery. The incidences of early recurrent VH were 22.2%, 10.8%, and 32.4% in groups 1, 2, and 3, respectively (P = 0.087). A subgroup pairwise analysis showed significantly decreased early VH incidence in group 2 compared with that of group 3 (P = 0.026). The incidences of late recurrent VH were 11.1%, 16.2%, and 14.7% in groups 1, 2, and 3, respectively (P = 0.813). The ITVC in groups 1, 2, and 3 were 26.4 ± 42.5 days, 10.3 ± 8.2 days, and 25.2 ± 26.1 days, respectively. The ITVC was significantly shorter in group 2 compared with that in groups 1 and 3 (P = 0.045 and P = 0.015, respectively). The BCVA at 6 months after surgery did not differ significantly among the 3 groups (P = 0.418). This study found no substantial evidence to support the adjunctive use of preoperative IVB to reduce postoperative recurrence of VH in vitrectomy for PDR. For select cases in which adjunctive IVB use is considered, intraoperative administration seems to be the better option for reducing postoperative VH. The author(s) have no proprietary or commercial interest in any materials discussed in this article. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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            ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOR PROLIFERATIVE DIABETIC RETINOPATHY

            To systematically review and perform meta-analysis on the available randomized controlled trial data for anti-vascular endothelial growth factor (anti-VEGF) agents in the management of proliferative diabetic retinopathy and its complications.
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              INTRAVITREAL CONBERCEPT (KH902) FOR SURGICAL TREATMENT OF SEVERE PROLIFERATIVE DIABETIC RETINOPATHY.

              To evaluate the role, safety, and effectiveness of intravitreal conbercept (KH902) injections as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy.
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                Author and article information

                Journal
                Br J Ophthalmol
                Br J Ophthalmol
                bjophthalmol
                bjo
                The British Journal of Ophthalmology
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0007-1161
                1468-2079
                August 2018
                15 December 2017
                : 102
                : 8
                : 1077-1085
                Affiliations
                [1] departmentDepartment of Ophthalmology , Peking Union Medical College Hospital, Chinese Academy of Medical Sciences , Beijing, China
                Author notes
                [Correspondence to ] Dr You-xin Chen, Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China; 478252553@ 123456qq.com
                Article
                bjophthalmol-2017-311344
                10.1136/bjophthalmol-2017-311344
                6059039
                29246890
                87e6be04-5a3e-44b7-9d32-daf54e2c57a6
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 20 September 2017
                : 02 November 2017
                : 21 November 2017
                Categories
                Clinical Science
                1506
                Custom metadata
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                Ophthalmology & Optometry
                vascular endothelial growth factor,proliferative diabetic retinopathy,vitrectomy,meta-analysis

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