Skip to main content

Advertisement

SpringerLink
Log in

Intravitreal ranibizumab versus vitrectomy for recurrent vitreous haemorrhage after pars plana vitrectomy for proliferative diabetic retinopathy: a prospective study

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To compare prospectively intravitreal ranibizumab treatment and pars plana vitrectomy (PPV) in patients with recurrent vitreous haemorrhage (VH) due to proliferative diabetic retinopathy (PDR), who were previously treated with PPV.

Methods

Participants in this prospective study were 37 patients (37 eyes) with PDR, previously treated with PPV. All patients presented recurrent VH and were treated with either ranibizumab (n = 18) or PPV (n = 19). All participants were examined at week 2 post-treatment and every month thereafter for 1 year. Main outcomes were the need of PPV, the rate of recurrence of VH and the change in visual acuity by the end of the 12-month follow-up.

Results

At month 12, there was statistically significant improvement in visual acuity in both groups compared to baseline, but the two groups did not differ regarding the change in visual acuity. In ranibizumab group, two patients presented recurrent VH during the follow-up and one patient needed PPV to clear the VH by month 12. In PPV group, two patients had mild recurrent VH, which cleared itself. No statistically significant difference was noticed regarding the rate of recurrent VH and the need of PPV between the two groups.

Conclusion

Intravitreal ranibizumab seems to be a safe and effective treatment alternative in patients with recurrent VH secondary to PDR, who had been previously treated with PPV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27:1047–1053

    Article  Google Scholar 

  2. Antonetti DA, Klein R, Gardner TW (2012) Diabetic retinopathy. N Engl J Med 366:1227–1239

    Article  CAS  Google Scholar 

  3. Madonna R, Balistreri CR, Geng YJ, De Caterina R (2017) Diabetic microangiopathy: pathogenetic insights and novel therapeutic approaches. Vasc Pharmacol 90:1–7

    Article  CAS  Google Scholar 

  4. Malecaze F, Clamens S, Simorre-Pinatel V, Mathis A, Chollet P, Favard C, Bayard F, Plouet J (1994) Detection of vascular endothelial growth factor messenger RNA and vascular endothelial growth factor-like activity in proliferative diabetic retinopathy. Arch Ophthalmol 112:1476–1482

    Article  CAS  Google Scholar 

  5. Xu Y, Cheng Q, Yang B, Yu S, Xu F, Lu L, Liang X (2015) Increased sCD200 levels in vitreous of patients with proliferative diabetic retinopathy and its correlation with VEGF and proinflammatory cytokines. Invest Ophthalmol Vis Sci 56:6565–6572

    Article  CAS  Google Scholar 

  6. Yeh PT, Yang CM, Yang CH, Huang JS (2005) Cryotherapy of the anterior retina and sclerotomy sites in diabetic vitrectomy to prevent recurrent vitreous hemorrhage: an ultrasound biomicroscopy study. Ophthalmology 112:2095–2102

    Article  Google Scholar 

  7. Schachat AP, Oyakawa RT, Michels RG, Rice TA (1983) Complications of vitreous surgery for diabetic retinopathy. II. Postoperative complications. Ophthalmology 90:522–530

    Article  CAS  Google Scholar 

  8. Soto-Pedre E, Hernaez-Ortega MC, Vazquez JA (2005) Risk factors for postoperative hemorrhage after vitrectomy for diabetic retinopathy. Ophthalmic Epidemiol 12:335–341

    Article  Google Scholar 

  9. Brown GC, Tasman WS, Benson WE, McNamara JA, Eagle RC Jr. (1992) Reoperation following diabetic vitrectomy. Arch Ophthalmol 110:506–510

    Article  CAS  Google Scholar 

  10. Yan H, Cui J, Lu Y, Yu J, Chen S, Xu Y (2010) Reasons for and management of postvitrectomy vitreous hemorrhage in proliferative diabetic retinopathy. Curr Eye Res 35:308–313

    Article  Google Scholar 

  11. Hershberger VS, Augsburger JJ, Hutchins RK, Raymond LA, Krug S (2004) Fibrovascular ingrowth at sclerotomy sites in vitrectomized diabetic eyes with recurrent vitreous hemorrhage: ultrasound biomicroscopy findings. Ophthalmology 111:1215–1221

    Article  Google Scholar 

  12. Kim DY, Kim JG, Kim YJ, Joe SG, Lee JY (2014) Ultra-widefield fluorescein angiographic findings in patients with recurrent vitreous hemorrhage after diabetic vitrectomy. Invest Ophthalmol Vis Sci 55:7040–7046

    Article  Google Scholar 

  13. Bhavsar AR, Torres K, Glassman AR, Jampol LM, Kinyoun JL, Diabetic Retinopathy Clinical Research Network (2014) Evaluation of results 1 year following short-term use of ranibizumab for vitreous hemorrhage due to proliferative diabetic retinopathy. JAMA Ophthalmol 132:889–890

    Article  Google Scholar 

  14. Yeh PT, Yang CH, Yang CM (2011) Intravitreal bevacizumab injection for recurrent vitreous haemorrhage after diabetic vitrectomy. Acta Ophthalmol 89:634–640

    Article  CAS  Google Scholar 

  15. Gross JG, Glassman AR, Jampol LM, Inusah S, Aiello LP, Antoszyk AN, Baker CW, Berger BB, Bressler NM, Browning D, Elman MJ, Ferris FL 3rd, Friedman SM, Marcus DM, Melia M, Stockdale CR, Sun JK, Beck RW (2015) Panretinal photocoagulation vs intravitreous Ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial. JAMA 314:2137–2146

    Article  CAS  Google Scholar 

  16. Wu B, Wu H, Liu X, Lin H, Li J (2014) Ranibizumab versus bevacizumab for ophthalmic diseases related to neovascularisation: a meta-analysis of randomised controlled trials. PLoS ONE 9:e101253

    Article  Google Scholar 

  17. Schmucker C, Ehlken C, Agostini HT, Antes G, Ruecker G, Lelgemann M, Loke YK (2012) A safety review and meta-analyses of bevacizumab and ranibizumab: off-label versus gold standard. PLoS ONE 7:e42701

    Article  CAS  Google Scholar 

  18. Holladay JT (1997) Proper method for calculating average visual acuity. J Refract Surg 13:388–391

    CAS  PubMed  Google Scholar 

  19. Simunovic MP, Maberley DA (2015) Anti-vascular endothelial growth factor therapy for proliferative diabetic retinopathy: a systematic review and meta-analysis. Retina 35:1931–1942

    Article  CAS  Google Scholar 

  20. Ruiz-Moreno JM, Montero JA, Lugo F, Amat P, Staicu C (2008) Intravitreal bevacizumab in recurrent diabetic vitreous haemorrhage after vitrectomy. Acta Ophthalmol 86:231–232

    Article  Google Scholar 

  21. Ferenchak K, Duval R, Cohen JA, MacCumber MW (2014) Intravitreal bevacizumab or postoperative recurrent vitreous hemorrhage after vitrectomy for proliferative diabetic retinopathy. Retina 34:1177–1181

    Article  CAS  Google Scholar 

  22. Moreno MR, Tabitha TS, Nirmal J, Radhakrishnan K, Yee CH, Lim S, Venkatraman S, Agrawal R (2016) Study of stability and biophysical characterization of ranibizumab and aflibercept. Eur J Pharm Biopharm 108:156–167

    Article  CAS  Google Scholar 

  23. Zhang L, Wang W, Gao Y, Lan J, Xie L (2016) The efficacy and safety of current treatments in diabetic macular edema: a systematic review and network meta-analysis. PLoS ONE 11:e0159553

    Article  Google Scholar 

  24. Avery RL, Gordon GM (2016) systemic safety of prolonged monthly anti-vascular endothelial growth factor therapy for diabetic macular edema: a systematic review and meta-analysis. JAMA Ophthalmol 134:21–29

    Article  Google Scholar 

  25. Chelala E, Nehme J, El Rami H, Aoun R, Dirani A, Fadlallah A, Jalkh A (2018) Efficacy of intravitreal ranibizumab injections in the treatment of vitreous hemorrhage related to proliferative diabetic retinopathy. Retina 38:1127–1133

    Article  CAS  Google Scholar 

  26. Diabetic Retinopathy Clinical Research Network (2013) Randomized clinical trial evaluating intravitreal ranibizumab or saline for vitreous hemorrhage from proliferative diabetic retinopathy. JAMA Ophthalmol 131:283–293

    Article  Google Scholar 

  27. Arevalo JF, Maia M, Flynn HW Jr, Saravia M, Avery RL, Wu L, Eid Farah M, Pieramici DJ, Berrocal MH, Sanchez JG (2008) Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy. Br J Ophthalmol 92:213–216

    Article  CAS  Google Scholar 

  28. Lee SJ, Koh HJ (2009) Enlargement of the foveal avascular zone in diabetic retinopathy after adjunctive intravitreal bevacizumab (avastin) with pars plana vitrectomy. J Ocul Pharmacol Ther 25:173–174

    Article  CAS  Google Scholar 

  29. Ficker L, Meredith TA, Gardner S, Wilson LA (1990) Cefazolin levels after intravitreal injection. Effects of inflammation and surgery. Invest Ophthalmol Vis Sci 31:502–505

    CAS  PubMed  Google Scholar 

  30. Kakinoki M, Sawada O, Sawada T, Saishin Y, Kawamura H, Ohji M (2012) Effect of vitrectomy on aqueous VEGF concentration and pharmacokinetics of bevacizumab in macaque monkeys. Invest Ophthalmol Vis Sci 53:5877–5880

    Article  CAS  Google Scholar 

Download references

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. 2nd Department of Ophthalmology, Attikon Hospital, National and Kapodistrian University of Athens, 1, Rimini street, 12462, Haidari, Greece

    Irini Chatziralli, Eleni Dimitriou, George Theodossiadis, Evgenia Bourouki & Panagiotis Theodossiadis

  2. Department of Ophthalmology, University of Ioannina, Ioannina, Greece

    Eleni Bagli & George Kitsos

Authors
  1. Irini Chatziralli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eleni Dimitriou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. George Theodossiadis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Evgenia Bourouki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eleni Bagli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. George Kitsos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Panagiotis Theodossiadis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Irini Chatziralli.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants, or other equity interest), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in this study were in accordance with the 1964 Declaration of Helsinki and its later amendments. The study was approved by the institutional review board of the participating hospital.

Informed consent

Informed consent was obtained from all participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chatziralli, I., Dimitriou, E., Theodossiadis, G. et al. Intravitreal ranibizumab versus vitrectomy for recurrent vitreous haemorrhage after pars plana vitrectomy for proliferative diabetic retinopathy: a prospective study. Int Ophthalmol 40, 841–847 (2020). https://doi.org/10.1007/s10792-019-01244-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-019-01244-z

Keywords

Search

Navigation