Shaanxi Eye Hospital, Xi'an People's Hospital (Xi'an Fourth Hospital), Xi'an, China.
Front Endocrinol (Lausanne). 2023 Feb 22;14:1098165. doi: 10.3389/fendo.2023.1098165. eCollection 2023.
Intravitreal Conbercept (IVC) has been shown to be effective in treating proliferative diabetic retinopathy (PDR) as an adjuvant in pars plana vitrectomy (PPV); however, the best timing of IVC injection remains unknown. This network meta-analysis (NMA) sought to ascertain the comparative efficacy of different timings of IVC injection as an adjuvant to PPV on PDR.
A comprehensive literature search was conducted in PubMed, EMBASE, and the Cochrane Library to identify relevant studies published before August 11, 2022. According to the mean time of IVC injection before PPV, the strategy was defined as very long interval if it was > 7 days but ≤ 9 days, long interval if it was > 5 days but ≤ 7 days, mid interval if it was > 3 days but ≤ 5 days, and short interval if it was ≤ 3 days, respectively. The strategy was defined as perioperative IVC if IVC was injected both before and at the end of PPV, and the strategy was intraoperative IVC if injected immediately at the end of PPV. The mean difference (MD) and odds ratio (OR) with corresponding 95% confidence interval (CI) for continuous and binary variables, respectively, were computed through network meta-analysis using Stata 14.0 MP.
Eighteen studies involving 1149 patients were included. There was no statistical difference between intraoperative IVC and control in treating PDR. Except for a very long interval, preoperative IVC significantly shortened operation time, and reduced intraoperative bleeding and iatrogenic retinal breaks. Long and short intervals reduced endodiathermy application, and mid and short intervals reduced postoperative vitreous hemorrhage. Moreover, long and mid intervals improved BCVA and central macular thickness. However, very long interval was associated with an increased risk of postoperative vitreous hemorrhage (RR: 3.27, 95%CI: 1.84 to 5.83). Moreover, mid interval was better than intraoperative IVC in shortening operation time (MD: -19.74, 95%CI: -33.31 to -6.17).
There are no discernible effects of intraoperative IVC on PDR, but preoperative IVC, except for very long interval, is an effective adjuvant to PPV for treating PDR.
玻璃体内注射康柏西普（IVC）已被证明在辅助玻璃体切割术（PPV）治疗增生性糖尿病视网膜病变（PDR）方面是有效的；然而，IVC 注射的最佳时机仍不清楚。本网络荟萃分析（NMA）旨在确定 IVC 注射作为辅助 PPV 治疗 PDR 时不同时间点的比较疗效。
在 PubMed、EMBASE 和 Cochrane 图书馆中进行全面的文献检索，以确定截至 2022 年 8 月 11 日之前发表的相关研究。根据 IVC 注射到 PPV 前的平均时间，将策略定义为非常长间隔（>7 天但≤9 天）、长间隔（>5 天但≤7 天）、中间隔（>3 天但≤5 天）和短间隔（≤3 天）。如果 IVC 在 PPV 之前和结束时都注射，则将策略定义为围手术期 IVC，如果立即在 PPV 结束时注射，则将策略定义为术中 IVC。使用 Stata 14.0 MP 通过网络荟萃分析计算连续和二分类变量的均数差（MD）和比值比（OR）及其相应的 95%置信区间（CI）。
纳入了 18 项研究，共 1149 名患者。术中 IVC 与对照组在治疗 PDR 方面无统计学差异。除非常长间隔外，术前 IVC 可显著缩短手术时间，并减少术中出血和医源性视网膜裂孔。长间隔和短间隔减少了内电凝的应用，中间隔和短间隔减少了术后玻璃体积血。此外，长间隔和中间隔改善了 BCVA 和中心黄斑厚度。然而，非常长间隔与术后玻璃体积血风险增加相关（RR：3.27，95%CI：1.84 至 5.83）。此外，中间隔在缩短手术时间方面优于术中 IVC（MD：-19.74，95%CI：-33.31 至-6.17）。
术中 IVC 对 PDR 没有明显影响，但除非常长间隔外，术前 IVC 是治疗 PDR 的有效辅助 PPV 方法。
