Abstract
Purpose
To evaluate the efficacy of intravitreal conbercept (IVC) in pars plana vitrectomy (PPV) for patients with proliferative diabetic retinopathy (PDR).
Methods
A meta-analysis of randomized control trials (RCTs) using online databases was performed. The intraoperative outcome measures were the incidence of intraoperative bleeding and endodiathermy application, and the mean surgical time. The postoperative outcome measures were mean change in best-corrected visual acuity (BCVA) from baseline, postoperative vitreous clear-up time and incidence of recurrent vitreous hemorrhage (VH).
Results
Eight RCTs were selected for meta-analysis. They included 409 eyes (215 eyes in IVC group and 194 eyes in no conbercept group). Preoperative IVC application was associated with less intraoperative bleeding and endodiathermy applications (RR = 0.34, 95% CI, 0.23–0.50, P < 0.00001, and RR = 0.26, 95% CI, 0.12–0.56, P = 0.0005) compared to no conbercept. It also shortened surgical time (WMD = −15.87, 95% CI, −22.04 to −9.69, P < 0.00001). In addition, preoperative or intraoperative IVC achieved better BCVA outcome (WMD = −0.37, 95% CI, −0.62 to −0.13, P = 0.003), shorter vitreous clear-up time postoperatively (WMD = −5.44, 95% CI, −6.31 to −4.57, P < 0.00001) and a lower rate of VH recurrence (RR = 0.45, 95% CI, 0.22–0.91, P = 0.03).
Conclusion
IVC is an effective adjuvant in PPV for PDR, with better intraoperative and postoperative outcomes.
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References
Frank RN. Diabetic retinopathy. N Engl J Med. 2004;350:48–58.
Lee R, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond). 2015;2:17.
Blankenship GW, Machemer R. Long-term diabetic vitrectomy results. Ophthalmology. 1985;92:503–6.
Zhao XY, Xia S, Chen YX. Antivascular endothelial growth factor agents pretreatment before vitrectomy for complicated proliferative diabetic retinopathy: a meta-analysis of randomised controlled trials. Br J Ophthalmol. 2018;102:1077–85.
Pakzad-Vaezi K, Albiani DA, Kirker AW, et al. A randomized study comparing the efficacy of bevacizumab and ranibizumab as pre-treatment for pars plana vitrectomy in proliferative diabetic retinopathy. Ophthalmic Surg Lasers Imaging Retin. 2014;45:52–524.
Raczyńska D, Lisowska KA, Pietruczuk K, et al. The level of cytokines in the vitreous body of severe proliferative diabetic retinopathy patients undergoing posterior vitrectomy. Curr Pharm Des. 2018;24:3276–81.
Su L, Ren X, Wei H, et al. Intravitreal conbercept (KH902) for surgical treatment of severe proliferative diabetic retinaopathy. Retina. 2016;36:938–43.
Lu X, Sun X. Profile of conbercept in the treatment of neovascular age-related macular degeneration. Drug Des Devel Ther. 2015;9:2311–20.
Simunovic MP, Maberley DA. Anti-vascular endothelial growth factor therapy for proliferative diabetic retinopathy: a systematic review and meta-analysis. Retina. 2015;35:1931–42.
Zhang ZH, Liu HY, Hernandez-Da Mota SE, et al. Vitrectomy with or without preoperative intravitreal bevacizumab for proliferative diabetic retinopathy: a meta-analysis of randomized controlled trials. Am J Ophthalmol. 2013;156:106–15.
Zhao LQ, Zhu H, Zhao PQ, Hu YQ. A systematic review and meta-analysis of clinical outcomes of vitrectomy with or without intravitreal bevacizumab pretreatment for severe diabetic retinopathy. Br J Ophthalmol. 2011;95:1216–22.
Pranata R, Vania A Intravitreal conbercept improves outcome in patients undergoing vitrectomy for proliferative diabetic retinopathy: a systematic review and meta-analysis. J Evid Based Med 2020; https://doi.org/10.1111/jebm.12379. [Epub ahead of print].
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.
Lau J, Ioannidis JP, Schmid CH. Quantitative synthesis in systematic reviews. Ann Intern Med. 1997;127:820–6.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.
Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.
Yang X, Xu J, Wang R, et al. A randomized controlled trial of conbercept pretreatment before vitrectomy in proliferative diabetic retinopathy. J Ophthalmol. 2016;2016:2473234.
Cui J, Chen H, Lu H, et al. Efficacy and safety of intravitreal conbercept, ranibizumab, and triamcinolone on 23-gauge vitrectomy for patients with proliferative diabetic retinopathy. J Ophthalmol. 2018;2018:4927259.
Zhou J, Liu Z, Chen M, et al. Concentrations of VEGF and PlGF decrease in eyes after intravitreal conbercept injection. Diabetes Ther. 2018;9:2393–8.
Ren X, Bu S, Zhang X, et al. Safety and efficacy of intravitreal conbercept injection after vitrectomy for the treatment of proliferative diabetic retinopathy. Eye (Lond). 2019;33:1177–83.
Jiang T, Gu J, Zhang P, Chen W, Chang Q. The effect of adjunctive intravitreal conbercept at the end of diabetic vitrectomy for the prevention of post-vitrectomy hemorrhage in patients with severe proliferative diabetic retinopathy: a prospective, randomized pilot study. BMC Ophthalmol. 2020;20:43.
Gao S, Lin Z, Chen Y, et al. Intravitreal conbercept injection as an adjuvant in vitrectomy with silicone oil infusion for severe proliferative diabetic retinopathy. J Ocul Pharm Ther. 2020;36:304–10.
Li B, Li MD, Ye JJ, Chen Z, Guo ZJ, Di Y. Vascular endothelial growth factor concentration in vitreous humor of patients with severe proliferative diabetic retinopathy after intravitreal injection of conbercept as an adjunctive therapy for vitrectomy. Chin Med J (Engl). 2020;20:664–9.
Wisniewska-Kruk J, Klaassen I, Vogels IM, et al. Molecular analysis of blood-retinal barrier loss in the Akimba mouse, a model of advanced diabetic retinopathy. Exp Eye Res. 2014;122:123–31.
Morera Y, González R, Lamdan H, et al. Vaccination with a mutated variant of human vascular endothelial growth factor (VEGF) blocks VEGF-induced retinal neovascularization in a rabbit experimental model. Exp Eye Res. 2014;122:102–9.
Zou C, Zhao M, Yu J, et al. Difference in the vitreal protein profiles of patients with proliferative diabetic retinopathy with and without intravitreal conbercept injection. J Ophthalmol. 2018;2018:7397610.
Li X, Xu G, Wang Y, et al. Safety and efficacy of conbercept in neovascular age-related macular degeneration: results from a 12-month randomized phase 2 study: AURORA study. Ophthalmology. 2014;121:1740–7.
Chen G, Tzekov R, Li W, Jiang F, et al. Pharmacogenetics of complement factor H Y402H polymorphism and treatment of neovascular AMD with anti-VEGF agents: a meta-analysis. Sci Rep. 2015;5:14517.
El-Sabagh HA, Abdelghaffar W, Labib AM, et al. Preoperative intravitreal bevacizumab use as an adjuvant to diabetic vitrectomy: histopathologic findings and clinical implications. Ophthalmology. 2011;118:636–41.
Li H, Lei N, Zhang M, Li Y, Xiao H, Hao X. Pharmacokinetics of a long-lasting anti-VEGF fusion protein in rabbit. Exp Eye Res. 2012;97:154–9.
Beck RW, Moke PS, Turpin AH, et al. A computerized method of visual acuity testing: adaptation of the early treatment of diabetic retinopathy study testing protocol. Am J Ophthalmol. 2003;135:194–205.
Funding
Supported by the Science Research Foundation of Aier Eye Hospital Group (No.AM1901D3 to WS Li.); Innovation Guidance Project of Science and Technology Department of Hunan Province (No.2018SK50102 to WS Li) and Welfare Technology Applied Research Program Fund of Science Technology Department of Zhejiang Province (No.LGF18H120002 to YH Tong.)
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Chen, G.H., Tzekov, R., Mao, S.H. et al. Intravitreal conbercept as an adjuvant in vitrectomy for proliferative diabetic retinopathy: a meta-analysis of randomised controlled trials. Eye 36, 619–626 (2022). https://doi.org/10.1038/s41433-021-01474-5
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DOI: https://doi.org/10.1038/s41433-021-01474-5
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