Proliferative Diabetic Retinopathy
Conditions
Brief summary
Certain percent of the eyes with proliferative diabetic retinopathymay require pars plana vitrectomy (PPV) due to vitreous haemorrhage, proliferative membrane, and tractional retinal detachment. This study will compare intravitreal injection of anti-vascular endothelial growth factor (ranibizumab) versus sham injection before vitrectomy for PDR. The main focus is to see if pre-operative injection of ranibizuman can reduce peri-operative hemorrahge related complications.
Detailed description
Eyes responding to panretinal photocoagulation can remain stable for decades, but incomplete responses and relapses can occur in a certain percent of diabetic patients showing as proliferative diabetic retinopathy. At present vitrectomy is the main intervention for those eyes with vitreous hemorrhage, proliferative membrane, and tractional retinal detachment. And the surgical procedure might be complicated because of intraoperative bleeding. And post-operative complications might be also involved. Perioperative use of intraocular anti-VEGF might be associated with less hemorrhage related complications and better visula acuity. This study will compare intravitreal injection of anti-vascular endothelial growth factor (ranibizumab) versus sham injection one week before surgery. The investigators tried to make sure whether pre-operative injection of ranibizuman can reduce reduce intra-operative bleeding, reduce the frequency of using endodiathermy, decrease surgical time, improve microcurculation of retina, and elevte best-corrected visual acuity.
Interventions
DRUGranibizumab
intravitreal injection of 0.5 mg ranibizumab before vitrectomy
DRUGsham
sham intravitreal injection before vitrectomy
PROCEDUREpars plana vitrectomy
surgical procedure to remove the intravitreal hemorrhage and fibrosis membrane, and re-attach the retina, and perform endo laser photocoagulation on retina.
Sponsors
Sun Yat-sen University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* type I or type II diabetes * there is clear indications for vitrectomy due to proliferative membrane in the vitreoretinal interface, mild hemorrhage, or tractional retinal detachment * retinal large vessels could be detected within one PD away from the edge of optic disc by OCT * microcurculation could be detected by FFA in at least one quadrant * the patient could tolerant FFA examination
Exclusion criteria
* a history of vitrectomy or scleral bucke in the included eye * retinal laser photocoagulation treatment within 90 days in the included eye * anti-VEGF treatment with 90 days in either eye * there is cocurrent neovascular glaucoma in the included eye * any reason that might hinde the procedure of vitrectomy, FFA OCT or the observation of ocular fudus * a history of cere-brovascular accident or heart stroke * renal failure * could not attend follow up regularly
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| perioperative hemorrhage of the surgical eye | 3 month |
Secondary
| Measure | Time frame |
|---|---|
| macular retinal thickness assessed with optical coherance tomography | 3 month |
| size of retinal non-perfusion area assessed by fluorescene angiography | 3 month |
| retinal vessel oxygen saturation measured with a retinal oximeter | 3 months |
| best-corrected visual acuity | 3 months |
Other
| Measure | Time frame | Description |
|---|---|---|
| grade of surgical difficulty | 1 day | — |
| surgical time | 1 day | — |
| complications | 3 months | other perioperative complications |
Countries
China
Outcome results
None listed