Intravitreal conbercept injection with panretinal photocoagulation for high-risk proliferative diabetic retinopathy with vitreous hemorrhage

Abstract

Aim: To assess the clinical efficacy and safety of combining panretinal photocoagulation (PRP) with intravitreal conbercept (IVC) injections for patients with high-risk proliferative diabetic retinopathy (HR-PDR) complicated by mild or moderate vitreous hemorrhage (VH), with or without diabetic macular edema (DME).

Methods: Patients diagnosed with VH with/without DME secondary to HR-PDR and received PRP combined with IVC injections were recruited in this retrospective study. Upon establishing the patient's diagnosis, an initial IVC was performed, followed by prompt administration of PRP. In cases who significant bleeding persisted and impeded the laser operation, IVC was sustained before supplementing with PRP. Following the completion of PRP, patients were meticulously monitored for a minimum of six months. Laser therapy and IVC injections were judiciously adjusted based on fundus fluorescein angiography (FFA) results. Therapeutic effect and the incidence of adverse events were observed.

Results: Out of 42 patients (74 eyes), 29 were male and 13 were female, with a mean age of 59.17±12.74y (33-84y). The diabetic history was between 1wk and 26y, and the interval between the onset of visual symptoms and diagnosis of HR-PDR was 1wk-1y. The affected eye received 2.59±1.87 (1-10) IVC injections and underwent 5.5±1.02 (4-8) sessions of PRP. Of these, 68 eyes received PRP following 1 IVC injection, 5 eyes after 2 IVC injections, and 1 eye after 3 IVC injections. Complete absorption of VH was observed in all 74 eyes 5-50wk after initial treatment, with resolution of DME in 51 eyes 3-48wk after initial treatment. A newly developed epiretinal membrane was noted in one eye. Visual acuity significantly improved in 25 eyes. No complications such as glaucoma, retinal detachment, or endophthalmitis were reported.

Conclusion: The study suggests that the combination of PRP with IVC injections is an effective and safe modality for treating diabetic VH in patients with HR-PDR.

Keywords: conbercept; high-risk proliferative diabetic retinopathy; panretinal photocoagulation; vitreous hemorrhage.

Figure 1. A 34-year-old male patient and HR-PDR with VH received PRP combined with IVC treatment

A: At the first visit, logMAR BCVA was 1.1 in the right eye and 1.2 in the left eye. Color fundus images showed opacities in both eyes with VH and cotton wool sports. B: FFA revealed fluorescent shading due to VH, with numerous microaneurysms, NPAs, and fluorescence leakage observed in the retina. C: OCT showed intraretinal fluid in both eyes. D-E: Three months after the initial visit, both eyes received three IVC injections and PRP. Fundus imaging showed that most of the VH had been absorbed, with a small amount of bleeding and exudation observed in the retina. FFA showed bleeding and retinal NPAs without NV. F: Eight months later, new macular edema was observed in both eyes, and three IVC injections were administered in both eyes over six months. G: Sixteen months later, logMAR BCVA was 0 in the right eye and 0.3 in the left eye. FFA showed NPAs in the inferior part of the left eye. H-I: Eighteen months later, ultra-wide-field scanning laser ophthalmoscopic images revealed no VH, or exudation. OCT showed normal macula in both eyes. BCVA: Best-corrected visual acuity; FFA: Fundus fluorescein angiography; VH: Vitreous hemorrhage; NPAs: Non-perfusion areas; OCT: Optical coherence tomography; IVC: Intravitreal conbercept; PRP: Panretinal photocoagulation; NV: Neovascularization; HR-PDR: High-risk proliferative diabetic retinopathy.