Efficacy of intravitreal injection of Ziv-aflibercept before vitrectomy for proliferative diabetic retinopathy

Abstract

Purpose The aim of this study was to evaluate the efficacy of intravitreal injection of Ziv-aflibercept before small-gauge pars plana vitrectomy compared to pars plana vitrectomy alone in eyes with advanced diabetic eye disease. Patients and methods This is a prospective, randomized, interventional study that enrolled 60 eyes of 46 patients with advanced diabetic eye disease between February 2019 and December 2020. Intravitreal Ziv-aflibercept injection was given in 30 eyes before vitrectomy, while the other 30 eyes served as the control group (without intravitreal injection). The recorded data included intraoperative bleeding, surgical time, endodiathermy use, iatrogenic retinal breaks, and incidence of postoperative vitreous hemorrhage at 1 week, 1 month, 3, 6, and 12 months postoperatively. Results Intraoperative bleeding was noted in 18 (60%) eyes in the study group compared to 26 (86.66%) eyes in the control group, with no statistically significant difference (P=0.39). However, grade 2 intraoperative bleeding was reported significantly less in the study group (eight eyes, 26.66%) than in the control group (20 eyes, 66.66%) (P=0.004). At least one intraoperative iatrogenic retinal break was detected in 10 (33.33%) eyes in the study group compared to 18 (60%) eyes in the control group (P=0.44). The mean surgical time was significantly shorter (51.67±7.30 min) in the study group than in the control group (63.17±10.16 min) (P<0.001). However, there was no statistically significant difference in the rate of postoperative vitreous hemorrhage between the study group and the control group at 1 week, 1, 3, 6, and 12 months, postoperatively (P>0.05). Conclusion Preoperative intravitreal Ziv-aflibercept significantly decreased the surgical time and reduced the rate of severe intraoperative bleeding during diabetic vitrectomy.