Intra- and postoperative clinical outcome and safety profile of small-gauge vitrectomy with preoperative intravitreal ranibizumab for proliferative diabetic retinopathy: A meta-analysis

In proliferative diabetic retinopathy (PDR), vitreous hemorrhage (VH) becomes a common complication and remains an ongoing challenge in achieving optimal surgical outcomes. This meta-analysis aims to analyse the intra- and postoperative outcome of adding intravitreal injection of ranibizumab before small-gauge pars plana vitrectomy (PPV), particularly to reduce VH incidence. We conducted systematic searching on five eligible databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols to find studies which compared outcome of small-gauge vitrectomy with and without preoperative intravitreal ranibizumab (IVR). The outcomes were assessed using mean difference (MD) and risk ratio (RR). Six studies were included in this meta-analysis with a total of 584 patients. Combination therapy of small-gauge vitrectomy with preoperative IVR significantly reduced the incidence of severe intraoperative bleeding (RR= 0.37; 95% confidence interval [CI] 0.22, 0.62; P = 0.0002), mild-severe early VH (RR= 0.47; 95% CI 0.24, 0.89; P = 0.002), and iatrogenic retinal break (RR= 0.47; 95% CI 0.31, 0.71; P = 0.0003). IVR significantly improved the best-corrected visual acuity after 1 and 3 months of PPV (MD= −0.15; 95% CI −0.24, −0.06; P = 0.0006). The mean of surgery time also significantly reduced in the IVR group (MD = −20.50; 95% CI −36.48, −4.52; P = 0.01). In conclusion, small-gauge PPV with preoperative IVR injection offers significant intra-and postoperative outcomes in PDR patients.