Perioperative anti-vascular endothelial growth factor treatment in diabetic vitrectomy: A narrative review

With the rising prevalence of diabetes mellitus globally, vision-threatening diabetic retinopathy (DR) is also rapidly increasing. Due to the advent of newer instrumentation, the indications of pars plana vitrectomy (PPV) in such advanced DR patients have also expanded. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are also increasingly being used in patients with DR, often as an adjunct to PPV. This narrative review was conducted to summarize and critically analyze the role of perioperative anti-VEGF therapy in diabetic vitrectomy. Various indications of diabetic vitrectomy where perioperative anti-VEGF is used have been elucidated. Controversies regarding the optimal timing of preoperative anti-VEGF therapy prior to vitrectomy have been addressed in detail. This review also elaborates the various intraoperative and postoperative benefits of anti-VEGFs with regard to the duration of vitrectomy, intraoperative bleeding, iatrogenic breaks, need for endodiathermy and silicon oil endotamponade, surgical difficulty score, postoperative visual gain, intraocular pressures, postoperative vitreous cavity hemorrhage, and need for second surgery. The current narrative also mentions the potential ocular adverse effects of anti-VEGF, such as progression of tractional retinal detachment, apart from addressing other ocular side effects and a few other uncommon yet serious systemic adverse events.