Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 May 31;5(5):CD008214.
doi: 10.1002/14651858.CD008214.pub4.

Anti-vascular endothelial growth factors in combination with vitrectomy for complications of proliferative diabetic retinopathy

Panagiotis Dervenis  1   2 , Nikolaos Dervenis  3   4 , Jonathan M Smith  5 , David Hw Steel  5   6
Affiliations
Review

Anti-vascular endothelial growth factors in combination with vitrectomy for complications of proliferative diabetic retinopathy

Panagiotis Dervenis et al. Cochrane Database Syst Rev. .

Abstract

Background: Vitrectomy is an established treatment for the complications of proliferative diabetic retinopathy (PDR). However, a number of complications can occur during and after vitrectomy for PDR. These include bleeding and the creation of retinal holes during surgery, and bleeding, retinal detachment and scar tissue on the retina after surgery. These complications can limit vision, require further surgery and delay recovery. The use of anti-vascular endothelial growth factor (anti-VEGF) agents injected into the eye before surgery has been proposed to reduce the occurrence of these complications. Anti-VEGF agents can reduce the amount and vascularity of abnormal new vessels associated with PDR, facilitating their dissection during surgery, reducing intra- and postoperative bleeding, and potentially improving outcomes.

Objectives: To assess the effects of perioperative anti-VEGF use on the outcomes of vitrectomy for the treatment of complications for proliferative diabetic retinopathy (PDR).

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 6); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 22 June 2022.

Selection criteria: We included randomised controlled trials (RCTs) that looked at the use of anti-VEGFs and the incidence of complications in people undergoing vitrectomy for PDR. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed and extracted the data. We used the standard methodological procedures expected by Cochrane. The critical outcomes of the review were the mean difference in best corrected visual acuity (BCVA) between study arms at six (± three) months after the primary vitrectomy, the incidence of early postoperative vitreous cavity haemorrhage (POVCH, within four weeks postoperatively), the incidence of late POVCH (occurring more than four weeks postoperatively), the incidence of revision surgery for POVCH within six months, the incidence of revision surgery for recurrent traction/macular pucker of any type and/or rhegmatogenous retinal detachment within six months and vision-related quality of life (VRQOL) measures. Important outcomes included the proportion of people with a visual acuity of counting fingers (1.8 logMAR or worse), the number of operative retinal breaks reported and the frequency of silicone oil tamponade required at time of surgery.

Main results: The current review includes 28 RCTs that looked at the pre- or intraoperative use of intravitreal anti-VEGFs to improve the outcomes of pars plana vitrectomy for complications of PDR. The studies were conducted in a variety of countries (11 from China, three from Iran, two from Italy, two from Mexico and the remaining studies from South Korea, the UK, Egypt, Brazil, Japan, Canada, the USA, Indonesia and Pakistan). The inclusion criteria for entry into the studies were the well-recognised complications of proliferative retinopathy: non-clearing vitreous haemorrhage, tractional retinal detachment involving the macula or combined tractional rhegmatogenous detachment. The included studies randomised a total of 1914 eyes. We identified methodological issues in all of the included studies. Risk of bias was highest for masking of participants and investigators, and a number of studies were unclear when describing randomisation methods and sequence allocation. Participants receiving intravitreal anti-VEGF in addition to pars plana vitrectomy achieved better BCVA at six months compared to people undergoing vitrectomy alone (mean difference (MD) -0.25 logMAR, 95% confidence interval (CI) -0.39 to -0.11; 13 studies, 699 eyes; low-certainty evidence). Pre- or intraoperative anti-VEGF reduced the incidence of early POVCH (12% versus 31%, risk ratio (RR) 0.44, 95% CI 0.34 to 0.58; 14 studies, 1038 eyes; moderate-certainty evidence). Perioperative anti-VEGF use was also associated with a reduction in the incidence of late POVCH (10% versus 23%, RR 0.47, 95% CI 0.30 to 0.74; 11 studies, 579 eyes; high-certainty evidence). The need for revision surgery for POVCH occurred less frequently in the anti-VEGF group compared with control, but the confidence intervals were wide and compatible with no effect (4% versus 13%, RR 0.44, 95% CI 0.15 to 1.28; 4 studies 207 eyes; moderate-certainty evidence). Similar imprecisely measured effects were seen for revision surgery for rhegmatogenous retinal detachment (5% versus 11%, RR 0.50, 95% CI 0.15 to 1.66; 4 studies, 145 eyes; low-certainty evidence). Anti-VEGFs reduce the incidence of intraoperative retinal breaks (12% versus 31%, RR 0.37, 95% CI 0.24 to 0.59; 12 studies, 915 eyes; high-certainty evidence) and the need for silicone oil (19% versus 41%, RR 0.46, 95% CI 0.27 to 0.80; 10 studies, 591 eyes; very low-certainty evidence). No data were available on quality of life outcomes or the proportion of participants with visual acuity of counting fingers or worse.

Authors' conclusions: The perioperative use of anti-VEGF reduces the risk of late POVCH, probably results in lower early POVCH risk and may improve visual outcomes. It also reduces the incidence of intraoperative retinal breaks. The evidence is very uncertain about its effect on the need for silicone oil tamponade. The reported complications from its use appear to be low. Agreement on variables included and outcome standardisation is required in trials studying vitrectomy for PDR.

Trial registration: ClinicalTrials.gov NCT01270542 NCT01805297 NCT01589718 NCT00516464 NCT00931125 NCT01091896 NCT01151722 NCT01306981.

PubMed Disclaimer

Conflict of interest statement

For the 2021 update (taken from CoI forms completed on 24 March 2021):

JS: No conflicts to declare ND: No conflicts to declare PD: No conflicts to declare DS: No conflicts to declare

Figures

1
1
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
4
4
5
5
6
6
7
7
1.1
1.1. Analysis
Comparison 1: Anti‐VEGF versus control, Outcome 1: Mean BCVA
1.2
1.2. Analysis
Comparison 1: Anti‐VEGF versus control, Outcome 2: Early POVCH
1.3
1.3. Analysis
Comparison 1: Anti‐VEGF versus control, Outcome 3: Late POVCH
1.4
1.4. Analysis
Comparison 1: Anti‐VEGF versus control, Outcome 4: Revision surgery for POVCH
1.5
1.5. Analysis
Comparison 1: Anti‐VEGF versus control, Outcome 5: Revision surgery for recurrent traction and/or RRD
1.6
1.6. Analysis
Comparison 1: Anti‐VEGF versus control, Outcome 6: Intraoperative retinal breaks
1.7
1.7. Analysis
Comparison 1: Anti‐VEGF versus control, Outcome 7: Silicone oil use
2.1
2.1. Analysis
Comparison 2: Anti‐VEGF versus control: subgroup analysis ‐ time of administration of anti‐VEGF, Outcome 1: Mean BCVA
2.2
2.2. Analysis
Comparison 2: Anti‐VEGF versus control: subgroup analysis ‐ time of administration of anti‐VEGF, Outcome 2: Early POVCH
3.1
3.1. Analysis
Comparison 3: Anti‐VEGF versus control: subgroup analysis ‐ main indication for vitrectomy, Outcome 1: Mean BCVA
4.1
4.1. Analysis
Comparison 4: Anti‐VEGF versus control: subgroup analysis ‐ bevacizumab versus other anti‐VEGF, Outcome 1: Mean BCVA
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Ahmadieh 2009 {published data only}
    1. Ahmadieh H, Shoeibi N, Entezari M, Monshizadeh R. Intravitreal bevacizumab for prevention of early postvitrectomy hemorrhage in diabetic patients: a randomized clinical trial. Ophthalmology 2009;116(10):1943-8. - PubMed
Ahn 2011 {published data only}
    1. Ahn J, Woo SJ, Chung H, Park KH. The effect of adjunctive intravitreal bevacizumab for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy. Ophthalmology 2011;118(11):2218-26. - PubMed
Aleman 2019 {published data only}
    1. Aleman I, Castillo Velazquez J, Rush SW, Rush RB. Ziv-aflibercept versus bevacizumab administration prior to diabetic vitrectomy: a randomised and controlled trial. British Journal of Ophthalmology 2019;103(12):1740-6. - PubMed
Arevalo 2019 {published data only}
    1. Arevalo JF, Lasave AF, Kozak I, Al Rashaed S, Al Kahtani E, Maia M, et al. Preoperative bevacizumab for tractional retinal detachment in proliferative diabetic retinopathy: a prospective randomized clinical trial. American Journal of Ophthalmology 2019;207:279-87. - PubMed
Comyn 2017 {published data only}
    1. Comyn O, Wickham L, Charteris DG, Sullivan PM, Ezra E, Gregor Z, et al. Ranibizumab pretreatment in diabetic vitrectomy: a pilot randomised controlled trial (the RaDiVit study). Eye 2017;31:1253-8. - PMC - PubMed
Cui 2018 {published data only}
    1. Cui J, Chen H, Lu H, Dong F, Wei D, Jiao Y, e al. Efficacy and safety of intravitreal conbercept, ranibizumab, and triamcinolone on 23-gauge vitrectomy for patients with proliferative diabetic retinopathy. Journal of Ophthalmology 2018;2018:4927259. [DOI: 10.1155/2018/4927259] - DOI - PMC - PubMed
di Lauro 2009 {published data only}
    1. di Lauro R, De Ruggiero P, di Lauro R, di Lauro MT, Romano MR. Intravitreal bevacizumab for the surgical treatment of severe proliferative retinopathy. Graefes Archive for Clinical and Experimental Ophthalmology 2010;248(6):785-91. - PubMed
Dong 2019 {published data only}
    1. Dong X. Effect of ranibizumab on the efficacy of vitrectomy in patients with PDR. International Eye Science 2019;19(5):809-12.
El Batarny 2008 {published data only}
    1. El Batarny AM. Intravitreal bevacizumab as an adjunctive therapy before diabetic vitrectomy. Clinical Ophthalmology 2008;2(4):709-16. - PMC - PubMed
Farahvash 2011 {published data only}
    1. Farahvash MS, Majidi AR, Roohipoor R, Ghassemi F. Preoperative injection of intravitreal bevacizumab in dense diabetic vitreous hemorrhage. Retina 2011;31(7):1254-60. - PubMed
Ferraz 2013 {published data only}
    1. Ferraz AJ, Morita C, Preti RC, Nascimento VP, Maia Junior OO, Carvalho de Barros A, et al. Use of intravitreal bevacizumab or triamcinolone acetonide as a preoperative adjunct to vitrectomy for vitreous haemorrhage in diabetics. Revista Brasileira de Oftalmologia 2013;72(1):12-6.
Hernández‐Da Mota 2010 {published data only}
    1. Hernández-Da Mota SE, Nuñez-Solorio SM. Experience with intravitreal bevacizumab as a preoperative adjunct in 23-G vitrectomy for advanced proliferative diabetic retinopathy. European Journal of Ophthalmology 2010;20(6):1047-52. - PubMed
Hu 2019 {published data only}
    1. Hu HT, Sun T, Wang H, Wu HX, Hao LX. Effect of ranibizumab injection on the surgical outcome and complications of PDR patients before PPV. International Eye Science 2019;19(5):817-20.
Jiang 2020 {published data only}
    1. 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 Ophthalmology 2020;20(1):43. - PMC - PubMed
Li 2022 {published data only}
    1. Li S, Yang Y, Zou J, Zeng J, Ding C. The efficacy and safety of intravitreal injection of Ranibizumab as pre‑treatment for vitrectomy in proliferative diabetic retinopathy with vitreous hemorrhage. BMC Ophthalmology 2022;22(1):63. - PMC - PubMed
Manabe 2015 {published data only}
    1. Manabe A, Shimada H, Hattori T, Nakashizuka H, Yuzawa M. Randomized controlled study of intravitreal bevacizumab 0.16 mg injected one day before surgery for proliferative diabetic retinopathy. Retina 2015;35(9):1800-7. - PubMed
Modarres 2009 {published data only}
    1. Modarres M, Nazari H, Falavarjani KG, Naseripour M, Hashemi M, Parvaresh MM. Intravitreal injection of bevacizumab before vitrectomy for proliferative diabetic retinopathy. European Journal of Ophthalmology 2009;19(5):848-52. - PubMed
Ou 2021 {published data only}
    1. Ou Z, Wang Q, Jiang J, Liu X. Intravitreal injection of Conbercept combined with PPV in the treatment of proliferative diabetic retinopathy. International Eye Science 2021;21(6):986-90.
Pakzad Vaezi 2014 {published data only}
    1. Pakzad-Vaezi K, Albiani DA, Kirker AW, Merkur AB, Kertes PJ, Eng KT, et al. A randomized study comparing the efficacy of bevacizumab and ranibizumab as pre-treatment for pars plana vitrectomy in proliferative diabetic retinopathy. Ophthalmic Surgery, Lasers and Imaging Retina 2014;45(6):521-4. - PubMed
Ren 2019 {published data only}
    1. Ren X, Bu S, Zhang X, Jiang Y, Tan L, Zhang H, et al. Safety and efficacy of intravitreal conbercept injection after vitrectomy for the treatment of proliferative diabetic retinopathy. Eye 2019;33(7):1177-83. - PMC - PubMed
Rizzo 2008 {published data only}
    1. Rizzo S, Genovesi-Ebert F, Di Bartolo E, Vento A, Miniaci S, Williams G. Injection of intravitreal bevacizumab (Avastin) as a preoperative adjunct before vitrectomy surgery in the treatment of severe proliferative diabetic retinopathy (PDR). Graefe's Archive for Clinical and Experimental Ophthalmology 2008;246(6):837-42. - PubMed
Sohn 2012 {published data only}
    1. Sohn EH, He S, Kim LA, Salehi-Had H, Javaheri M, Spee C, et al. Angiofibrotic response to vascular endothelial growth factor inhibition in diabetic retinal detachment: report no. 1. Archives of Ophthalmology 2012;130(9):1127-34. - PMC - PubMed
Su 2016 {published data only}
    1. Su L, Ren X, Wei H, Zhao L, Zhang X, Liu J, et al. Intravitreal conbercept (KH902) for surgical treatment of severe proliferative diabetic retinopathy. Retina 2016;36(5):938-43. - PubMed
Wildan 2019 {published data only}
    1. Wildan A, Winarto, Kristina TN. Aflibercept and bevacizumab injection effects on visual acuity of post vitrectomy diabetic retinopathy. Pakistan Journal of Medical and Health Sciences 2019;13(4):1214-8.
Yang 2016 {published data only}
    1. Yang X, Xu J, Wang R, Mei Y, Lei H, Liu J, et al. A randomized controlled trial of conbercept pretreatment before vitrectomy in proliferative diabetic retinopathy. Journal of Ophthalmology 2016;2016:2473234. [DOI: 10.1155/2016/2473234] - DOI - PMC - PubMed
Yu 2015 {published data only}
    1. Yu XQ, Cao GP, Tang MX. Effect of vitrectomy combined medication hyperplastic on patients with diabetic retinopathy. International Eye Science 2015;15(8):1402-4.
Zaman 2013 {published data only}
    1. Zaman Y, Rehman A, Memon AF. Intravitreal Avastin as an adjunct in patients with proliferative diabetic retinopathy undergoing pars plana vitrectomy. Pakistan Journal of Medical Science 2013;29(2):590-2. - PMC - PubMed
Zhou 2017 {published data only}
    1. Zhou YM, Lu YL, Huang JH. Clinical effect of 25G+ vitrectomy combined with intravitreal injection of conbercept in the treatment of severe proliferative diabetic retinopathy. International Eye Science 2017;17(12):2321-4.

References to studies excluded from this review

Abd 2020 {published data only}
    1. Abd Elhamid AH, Mohamed AAEA, Khattab AM. Intravitreal aflibercept injection with panretinal photocoagulation versus early vitrectomy for diabetic vitreous hemorrhage: randomized clinical trial. BMC Ophthalmology 2020;20(1):130. - PMC - PubMed
Abdelhakim 2011 {published data only}
    1. Abdelhakim MA, Macky TA, Mansour KA, Mortada HA. Bevacizumab (Avastin) as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series. Ophthalmic Research 2011;45(1):23-30. - PubMed
Albuquerque 2014 {published data only}
    1. Albuquerque TL, Pierozzi GS, Araujo AC, Neto NH, Carregal TB, Martins MC. Comparative, randomized, double blinded study of the use of anti-VEGF in patients with vitreous hemorrhage or tractional retinal detachment secondary to diabetic retinopathy. Investigative Ophthalmology and Visual Science 2014;55(13):ARVO E-abstract 4391.
Antoszyk 2020 {published data only}
    1. Antoszyk AN, Glassman AR, Beaulieu WT, Jampol LM, Jhaveri CD, Punjabi OS, et al. Effect of intravitreous aflibercept vs vitrectomy with panretinal photocoagulation on visual acuity in patients with vitreous hemorrhage from proliferative diabetic retinopathy: a randomized clinical trial. JAMA 2020;324(23):2383-95. - PMC - PubMed
Antoszyk 2021 {published data only}
    1. Antoszyk AN. Initial aflibercept versus vitrectomy with panretinal photocoagulation for vitreous hemorrhage (VH) from proliferative diabetic retinopathy (PDR): a DRCR retina network randomized clinical trial. Investigative Ophthalmology and Visual Science 2021;62(8):ARVO E-abstract 1113.
Berk Ergun 2014 {published data only}
    1. Berk Ergun S, Toklu Y, Cakmak HB, Raza S, Simsek S. The effect of intravitreal bevacizumab as a pretreatment of vitrectomy for diabetic vitreous hemorrhage on recurrent hemorrhage. Seminars in Ophthalmology 2015;30(3):177-80. - PubMed
Bhavsar 2014 {published data only}
    1. Bhavsar AR, Torres K, Glassman AR, Jampol LM, Kinyoun JL, Diabetic Retinopathy Clinical Research Network. Evaluation of results 1 year following short-term use of ranibizumab for vitreous hemorrhage due to proliferative diabetic retinopathy. JAMA Ophthalmology 2014;132(7):889-90. - PMC - PubMed
Castillo 2017 {published data only}
    1. Castillo J, Aleman I, Rush SW, Rush RB. Preoperative bevacizumab administration in proliferative diabetic retinopathy patients undergoing vitrectomy: a randomized and controlled trial comparing interval variation. American Journal of Ophthalmology 2017;183:1-10. - PubMed
Castillo 2018 {published data only}
    1. Castillo Velazquez J, Aleman I, Rush SW, Rush RB. Bevacizumab before diabetic vitrectomy: a clinical trial assessing 3 dosing amounts. Ophthalmology Retina 2018;2(10):1010-20. - PubMed
Chakraborty 2021 {published data only}
    1. Chakraborty D, Maiti A, Kelkar A, Sengupta S, Roy S, Bolisetty M, et al. Outcomes of preoperative bevacizumab in diabetics with nonclearing vitreous hemorrhage without tractional detachment - a quasi-randomized retrospective study. Indian Journal of Ophthalmology 2021;69(11):3283-7. - PMC - PubMed
Chatziralli 2020 {published data only}
    1. Chatziralli I, Dimitriou E, Theodossiadis G, Bourouki E, Bagli E, Kitsos G, et al. Intravitreal ranibizumab versus vitrectomy for recurrent vitreous haemorrhage after pars plana vitrectomy for proliferative diabetic retinopathy: a prospective study. International Ophthalmology 2020;40(4):841-7. - PubMed
Cheema 2010 {published data only}
    1. Cheema RA, Mushtaq J, Al-Khars W, Al-Askar E, Cheema MA. Role of intravitreal bevacizumab (Avastin) injected at the end of diabetic vitrectomy in preventing postoperative recurrent vitreous hemorrhage. Retina 2010;30(10):1646-50. - PubMed
Chelala 2018 {published data only}
    1. Chelala E, Nehme J, El Rami H, Aoun R, Dirani A, Fadlallah A, et al. Efficacy of intravitreal ranibizumab injections in the treatment of vitreous hemorrhage related to proliferative diabetic retinopathy. Retina 2018;38(6):1127-33. - PubMed
Chen 2020 {published data only}
    1. Chen HJ, Wang CG, Dou HL, Feng XF, Xu YM, Ma ZZ. Effect of intravitreal ranibizumab pretreatment on vitrectomy in young patients with proliferative diabetic retinopathy. Annals of Palliative Medicine 2020;9(1):82-9. - PubMed
Comyn 2019 {published data only}
    1. Comyn O, Lange C, Bainbridge JW. Vitreous and plasma cytokine levels in subjects with advanced proliferative diabetic retinopathy in the Ranibizumab in Diabetic Vitrectomy (RaDiVit) Study. Investigative Ophthalmology and Visual Science 2019;60(9):ARVO E-abstract 5362.
da R Lucena 2009 {published data only}
    1. da R Lucena D, Ribeiro JA, Costa RA, Barbosa JC, Scott IU, Figueiredo-Pontes LL, et al. Intraoperative bleeding during vitrectomy for diabetic tractional retinal detachment with versus without preoperative intravitreal bevacizumab (IBeTra study). British Journal of Ophthalmology 2009;93(5):688-91. - PubMed
Demir 2013 {published data only}
    1. Demir M, Oba E, Can E, Kara O, Cinar S. Effect of bevacizumab injection before vitrectomy on intravitreal hemorrhage in pseudophakic patients with proliferative diabetic retinopathy. Ophthalmology and Eye Diseases 2013;5:11-5. - PMC - PubMed
Dirani 2014 {published data only}
    1. Dirani A, Fadlallah A, Azar G, Chelala E, Nehme J, Alameddine R, et al. Intravitreal ranibizumab for vitreous hemorrhage in proliferative diabetic retinopathy. Investigative Ophthalmology and Visual Science 2014;55(13):ARVO E-abstract 4395.
Doganay 2010 {published data only}
    1. Doganay S, Koc B, Cankaya C, Duz C, Bilak S. The effect on surgical success of intravitreal bevacizumab given before pars plana vitrectomy in diabetic patients [Diyabetik olgularda pars plana vitrektomiden once uygulanan intravitreal bevacizumabın cerrahi başarıya etkisi]. Retina-Vitreus 2010;18(4):310-3.
Elwan 2013 {published data only}
    1. Elwan MM, Ghanem AA, Abousamra WA. Outcome of a single intravitreal bevacizumab injection on the visual acuity and course of pars plana vitrectomy in proliferative diabetic retinopathy . Current Eye Research 2013 Sep 27 [Epub ahead of print]. - PubMed
Feng 2018 {published data only}
    1. Feng J, Li B, Wen J, Jiang Y. Preoperative timing of intravitreal bevacizumab injection for proliferative diabetic retinopathy patients. Ophthalmic Research 2018;60(4):250-7. - PubMed
Forooghian 2016 {published data only}
    1. Forooghian F, Kertes PJ, Eng KT, Albiani DA, Kirker AW, Merkur AB, et al. Alterations in intraocular cytokine levels following intravitreal ranibizumab. Canadian Journal of Ophthalmology 2016;51(2):87-90. - PubMed
Gao 2020 {published data only}
    1. Gao S, Lin Z, Chen Y, Xu J, Zhang Q, Chen J, et al. Intravitreal conbercept injection as an adjuvant in vitrectomy with silicone oil infusion for severe proliferative diabetic retinopathy. Journal of Ocular Pharmacology and Therapeutics 2020;36(5):304-10. - PubMed
Goncu 2014 {published data only}
    1. Goncu T, Ozdek S, Unlu M. The role of intraoperative bevacizumab for prevention of postoperative vitreous hemorrhage in diabetic vitreous hemorrhage. European Journal of Ophthalmology 2014;24(1):88-93. - PubMed
Gupta 2008 {published data only}
    1. Gupta A, Gupta V, Gupta P, Dogra M. Preoperative intravitreal bevacizumab improves visual outcome in diabetic vitreous surgery. American Academy of Ophthalmology 2008:252.
Gupta 2012a {published data only}
    1. Gupta B, Sivaprasad S, Wong R, Laidlaw A, Jackson TL, McHugh D, et al. Visual and anatomical outcomes following vitrectomy for complications of diabetic retinopathy: the DRIVE UK study. Eye 2012;26(4):510-6. - PMC - PubMed
Gupta 2012b {published data only}
    1. Gupta A, Bansal R, Gupta V, Dogra MR. Six-month visual outcome after pars plana vitrectomy in proliferative diabetic retinopathy with or without a single preoperative injection of intravitreal bevacizumab. International Ophthalmology 2012;32(2):135-44. - PubMed
Haseeb 2019 {published data only}
    1. Haseeb U, Aziz-Ur-Rehman, Haseeb M. Visual outcomes of pars plana vitrectomy alone or with intravitreal bevacizumab in patients of diabetic vitreous haemorrhage. Journal of the College of Physicians and Surgeons - Pakistan 2019;29(8):728-31. - PubMed
Hu 2021 {published data only}
    1. Hu L, Chen Q, Du Z, Wang W, Zhao G. Evaluation of vitrectomy combined preoperative intravitreal ranibizumab and postoperative intravitreal triamcinolone acetonide for proliferative diabetic retinopathy. International Ophthalmology 2021;41(5):1635-42. - PubMed
Hu 2022 {published data only}
    1. Hu Z, Cao X, Chen L, Su Y, Ji J, Yuan S, et al. Monitoring intraocular proangiogenic and profibrotic cytokines within 7 days after adjunctive anti-vascular endothelial growth factor therapy for proliferative diabetic retinopathy. Acta Ophthalmologica 2022;100(3):e726-36. - PubMed
Ishikawa 2009 {published data only}
    1. Ishikawa K, Honda S, Tsukahara Y, Negi A. Preferable use of intravitreal bevacizumab as a pretreatment of vitrectomy for severe proliferative diabetic retinopathy. Eye 2009;23(1):108-11. - PubMed
Jiao 2014 {published data only}
    1. Jiao C, Spee C, He S, Mullins R, Eliott D, Hinton DR, et al. Angiofibrotic response to bevacizumab on fibrovascular membranes in proliferative diabetic retinopathy. Investigative Ophthalmology and Visual Science 2014;55(13):ARVO E-abstract 5821.
Jin‐An 2014 {published data only}
    1. Jin-An X, Qing-Yu B, An-Ming X. Changes of cytokines in the aqueous humor following avastin intravitreous injection. Chinese Journal of Tissue Engineering Research 2014;18(42):6805-10.
Jirawison 2012 {published data only}
    1. Jirawison C, Ittipunkul N. Intravitreal bevacizumab at the end of diabetic vitrectomy for prevention of postoperative vitreous hemorrhage: a comparative study. Journal of the Medical Association of Thailand 2012;95(Suppl 4):S136-42. - PubMed
Jorge 2021 {published data only}
    1. Jorge DM, Tavares Neto JEDS, Poli-Neto OB, Scott IU, Jorge R. Intravitreal bevacizumab (IVB) versus IVB in combination with pars plana vitrectomy for vitreous hemorrhage secondary to proliferative diabetic retinopathy: a randomized clinical trial. International Journal of Retina and Vitreous 2021;7(1):35. - PMC - PubMed
Karimov 2021 {published data only}
    1. Karimov M, Akhundova L. Anti-vascular endothelial growth factor therapy as an adjunct to diabetic vitrectomy. Open Ophthalmology Journal 2021;15(1):137-43.
Kasetty 2021 {published data only}
    1. Kasetty VM, Marcus DM, Singh H, Frazier H, Starnes D. Complications, compliance and 3-year outcomes after endolaserless vitrectomy with aflibercept monotherapy for PDR-related vitreous hemorrhage. Investigative Ophthalmology and Visual Science 2021;62(8):ARVO E-abstract 1119.
Kawano 2013 {published data only}
    1. Kawano S, Yamashita T, Sonoda Y, Yamakiri K, Sakamoto T. Post-operative hemorrhage after vitrectomy for proliferative diabetic retinopathy with or without pre-surgical intravitreal bevacizumab. Investigative Ophthalmology and Visual Science 2013;54(15):ARVO E-abstract 216.
Leonard 2014 {published data only}
    1. Leonard RE, Shah VA. Intravitreal aflibercept as a surgical adjuvant in severe proliferative diabetic retinopathy. Investigative Ophthalmology and Visual Science 2014;55(13):ARVO E-abstract 4401.
Li 2010 {published data only}
    1. Li CR, Sun SG, Hong W. Effect of intravitreal bevacizumab injection before vitrectomy on proliferative diabetic retinopathy. International Journal of Ophthalmology 2010;3(3):261-3. - PMC - PubMed
Li 2015 {published data only}
    1. Li JK, Wei F, Jin XH, Dai YM, Cui HS, Li YM. Changes in vitreous VEGF, bFGF and fibrosis in proliferative diabetic retinopathy after intravitreal bevacizumab. International Journal of Ophthalmology 2015;8(6):1202-6. - PMC - PubMed
Li 2016 {published data only}
    1. Li S, Yang Y, Zou J, Zeng J, Ding C. Effect of ranibizumab intravitreal injection before 23G-vitrectomy surgery in the treatment of patients with proliferative diabetic retinopathy. International Eye Science 2016;16(10):1959-61.
Li 2020 {published data only}
    1. 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. Chinese Medical Journal 2020;133(6):664-9. - PMC - PubMed
Liu 2019 {published data only}
    1. Liu Q, Xie P, Yuan S, Hu Z. Day regimes of CONbercept on cytokinEs of PDR patients undergoing vitrectomy trial (CONCEPT): effects of preoperative intravitreal conbercept on cytokines in the vitreous with proliferative diabetic retinopathy. Investigative Ophthalmology and Visual Science 2019;60(9):ARVO E-abstract 5372.
Lo 2009 {published data only}
    1. Lo WR, Kim SJ, Aaberg TM Sr, Bergstrom C, Srivastava SK, Yan J, et al. Visual outcomes and incidence of recurrent vitreous hemorrhage after vitrectomy in diabetic eyes pretreated with bevacizumab (Avastin). Retina 2009;29(7):926-31. - PMC - PubMed
Ma 2016 {published data only}
    1. Ma YC, Luo XQ, Ding RX. Clinical effect of intravitreal injection of ranibizumab for severe proliferative diabetic retinopathy. International Eye Science 2016;16(1):111-3.
Marcus 2017 {published data only}
    1. Marcus DM, Singh H, Farooq A, Starnes D, Walia H. Endolaserless vitrectomy with intravitreal aflibercept injection (IAI) for proliferative diabetic retinopathy (PDR)-related vitreous hemorrhage (LASER LESS TRIAL). Investigative Ophthalmology and Visual Science 2017;58(8):ARVO E-abstract 5036.
Meng 2016 {published data only}
    1. Meng N, Ren BC. Effect of intravitreal injection of bevacizumab for vitreous hemorrhage in patients with proliferative diabetic retinopathy. International Eye Science 2016;16(5):972-4.
NCT01589718 {unpublished data only}
    1. NCT01589718. A phase III randomized 1:1, masked, study of the safety, tolerability, and efficacy of intravitreal pre-op 0.3mg pegaptanib sodium versus sham, for adjuvant management of TRD and vit hem associated with PDR. clinicaltrials.gov/show/NCT01589718 (first received 2 May 2012).
Oshima 2009 {published data only}
    1. Oshima Y, Shima C, Wakabayashi T, Kusaka S, Shiraga F, Ohji M, et al. Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment. Ophthalmology 2009;116(5):927-38. - PubMed
Ozer 2022 {published data only}
    1. Ozer F, Tokuc EO, Albayrak MG, Akpinar G, Kasap M, Karabas VL. Comparison of before versus after intravitreal bevacizumab injection, growth factor levels and fibrotic markers in vitreous samples from patients with proliferative diabetic retinopathy. Graefes Archive for Clinical and Experimental Ophthalmology 2022;260(6):1899-906. - PubMed
Papavasileiou 2017 {published data only}
    1. Papavasileiou E, Vasalaki M, Garnavou-Xirou C, Velissaris S, Zygoura V, McHugh D, et al. Vitrectomy with fibrovascular membrane delamination for proliferative diabetic retinopathy with or without preoperative Avastin. Hellenic Journal of Nuclear Medicine 2017;20(Suppl):161. [DOI: 10.1111/j.1755-3768.2017.02313] - DOI - PubMed
Park 2010 {published data only}
    1. Park DH, Shin JP, Kim SY. Intravitreal injection of bevacizumab and triamcinolone acetonide at the end of vitrectomy for diabetic vitreous hemorrhage: a comparative study. Graefes Archive for Clinical and Experimental Ophthalmology 2010;248(5):641-50. - PubMed
Park 2021 {published data only}
    1. Park YJ, Ahn J, Kim TW, Park SJ, Joo K, Park KH, et al. Efficacy of bevacizumab for vitreous haemorrhage in proliferative diabetic retinopathy with prior complete panretinal photocoagulation. Eye 2021;35(11):3056-63. - PMC - PubMed
Pokroy 2011 {published data only}
    1. Pokroy R, Desai UR, Du E, Li Y, Edwards P. Bevacizumab prior to vitrectomy for diabetic traction retinal detachment. Eye 2011;28(8):989-97. - PMC - PubMed
Romano 2009a {published data only}
    1. Romano MR, Gibran SK, Marticorena J, Wong D, Heimann H. Can a preoperative bevacizumab injection prevent recurrent postvitrectomy diabetic vitreous haemorrhage? Eye 2009;23(8):1698-701. - PubMed
Romano 2009b {published data only}
    1. Romano MR, Gibran SK, Marticorena J, Wong D. Can an intraoperative bevacizumab injection prevent recurrent postvitrectomy diabetic vitreous hemorrhage? European Journal of Ophthalmology 2009;19(4):618-21. - PubMed
Sato 2013 {published data only}
    1. Sato T, Morita S, Bando H, Sato S, Ikeda T, Emi K. Early vitreous hemorrhage after vitrectomy with preoperative intravitreal bevacizumab for proliferative diabetic retinopathy. Middle East African Journal of Ophthalmology 2013;20(1):51-5. - PMC - PubMed
Shi 2020 {published data only}
    1. Shi SH, Xu F, Li M. Clinical study of conbercept in patients with proliferative diabetic retinopathy undergoing vitrectomy. International Eye Science 2020;20(5):852-5.
Starnes 2019 {published data only}
    1. Starnes DC, Lalane R, Walia H, Farooq A, Frazier H, Marcus W, et al. Endolaserless vitrectomy with intravitreal aflibercept injection (IAI) for proliferative diabetic retinopathy (PDR)-related vitreous hemorrhage: LASER LESS TRIAL 1-year results. Investigative Ophthalmology and Visual Science 2019;60(9):ARVO E-abstract 6559.
Sun 2017 {published data only}
    1. Sun L, Tao Y. Effects of Bevacizumab on CTGF and PEDF in proliferative membrane in patients with PDR. International Eye Science 2017;17(6):1051-4.
Sun 2022 {published data only}
    1. Sun H, Zou W, Zhang Z, Huang D, Zhao J, Qin B, et al. Vitreous inflammatory cytokines and chemokines, not altered after preoperative adjunctive conbercept injection, but associated with early postoperative macular edema in patients with proliferative diabetic retinopathy. Frontiers in Physiology 2022;13:846003. - PMC - PubMed
Tsubota 2019 {published data only}
    1. Tsubota K, Usui Y, Wakabayashi Y, Suzuki J, Ueda S, Goto H. Effectiveness of prophylactic intravitreal bevacizumab injection to proliferative diabetic retinopathy patients with elevated preoperative intraocular VEGF in preventing complications after vitrectomy. Clinical Ophthalmology 2019;13:1063-70. - PMC - PubMed
Turkseven Kumral 2021 {published data only}
    1. Turkseven Kumral E, Ercalik NY. Intravitreal ranibizumab versus aflibercept for diabetic macular edema in vitrectomized eyes: 12 month results. Seminars in Ophthalmology 2021;36(8):723-7. - PubMed
Victor 2014 {published data only}
    1. Victor AA, Gondhowiardjo TD, Waspadji S, Wanandi SI, Bachtiar A, Suyatna FD, et al. Effect of laser photocoagulation and bevacizumab intravitreal in proliferative diabetic retinopathy: review on biomarkers of oxidative stress. Medical Journal of Indonesia 2014;23(2):79-86.
Vidinova 2020 {published data only}
    1. Vidinova CN, Gouguchkova PT, Dimitrov T, Vidinov KN, Nocheva H. Comparative clinical and ultrastructural analysis of the results from ranibizumab and aflibercept in patients with PDR [Ultrastruktureller und klinischer Vergleich des Ergebnisses bei PDR-Patienten, behandelt mit Ranibizumab oder Aflibercept – von Grundlagenforschungen zu den klinischen Therapien]. Klinische Monatsblatter fur Augenheilkunde 2020;237(1):79-84. - PubMed
Wang 2019 {published data only}
    1. Wang J, Gao X, Liu J, Wang J, Zhang Y, Zhang T, et al. Effect of intravitreal conbercept treatment on the expression of long noncoding RNAs and mRNAs in proliferative diabetic retinopathy patients. Acta Opthalmologica 2019;97(6):e902-12. - PubMed
Wang 2020 {published data only}
    1. Wang XT, Li SY, Fan W, Li J, Feng RF, Zhang ZP, et al. Changes of vitreous cytokine levels in eyes with PDR after intravitreal injection of ranibizumab or triamcinolone acetonide. International Eye Science 2020;20(7):1158-63.
Yang 2008 {published data only}
    1. Yang CM, Yeh PT, Yang CH, Chen MS. Bevacizumab pretreatment and long-acting gas infusion on vitreous clear-up after diabetic vitrectomy. American Journal of Ophthalmology 2008;146(2):211-7. - PubMed
Yeh 2009 {published data only}
    1. Yeh PT, Yang CM, Lin YC, Chen MS, Yang CH. Bevacizumab pretreatment in vitrectomy with silicone oil for severe diabetic retinopathy. Retina 2009;29(6):768-74. - PubMed
Yeoh 2008 {published data only}
    1. Yeoh J, Williams C, Allen P, Buttery R, Chiu D, Clark B. Avastin as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series. Clinical and Experimental Ophthalmology 2008;36(5):449-54. - PubMed
Yeung 2010 {published data only}
    1. Yeung L, Liu L, Wu WC, Kuo YH, Chao AN, Chen KJ, et al. Reducing the incidence of early postoperative vitreous haemorrhage by preoperative intravitreal bevacizumab in vitrectomy for diabetic tractional retinal detachment. Acta Opthalmologica 2010;88(6):635-40. - PubMed
Yin 2017 {published data only}
    1. Yin N, Zhao S, Zhu HN. Efficacy comparison of conbercept and ranibizumab as pre-treatment for pars plana vitrectomy in proliferative diabetic retinopathy. International Eye Science 2017;17(7):1300-2.
Zeng 2017 {published data only}
    1. Zeng G, Li P, Ye Y. Effects of intravitreal injection of conbercept on vitrectomy for proliferative diabetic retinopathy. Chinese Journal of Experimental Ophthalmology 2017;35(10):920-3.
Zhou 2018a {published data only}
    1. Zhou J, Liu Z, Chen M, Luo ZH, Li YQ, Qi GY, et al. Concentrations of VEGF and PlGF decrease in eyes after intravitreal conbercept injection. Diabetes Therapy 2018;9(6):2393-8. - PMC - PubMed
Zhou 2018b {published data only}
    1. Zhou HS, Ma HZ, Liang WL, Yan SG. Effects of vitrectomy with preoperative intravitreal conbercept for proliferative diabetic retinopathy. International Eye Science 2018;18(2):363-6.

References to ongoing studies

ISRCTN79120387 {unpublished data only}79120387
    1. ISRCTN79120387. A randomised, single-masked, phase IV pilot study of the efficacy and safety of adjunctive intravitreal Avastin® (bevacizumab) in the prevention of early postoperative vitreous haemorrhage following diabetic vitrectomy. www.controlled-trials.com/ISRCTN79120387 (first received 18 September 2007).
NCT00516464 {unpublished data only}
    1. NCT00516464. Evaluation of ranibizumab in proliferative diabetic retinopathy (PDR) requiring vitrectomy. clinicaltrials.gov/ct2/show/NCT00516464 (first received 15 August 2007).
NCT00931125 {unpublished data only}
    1. NCT00931125. Randomized, double blinded, controlled, two-center study assessing the safety and efficacy of intravitreal ranibizumab as a preoperative adjunct treatment before vitrectomy surgery in proliferative diabetic retinopathy (PDR) compared to vitrectomy alone. clinicaltrials.gov/show/NCT00931125 (first received 2 July 2009).
NCT01091896 {unpublished data only}
    1. NCT01091896. Adjuvant intravitreal bevacizumab in pars plana vitrectomy for vitreous hemorrhage secondary to diabetic retinopathy. clinicaltrials.gov/show/NCT01091896 (first received 24 March 2010).
NCT01151722 {unpublished data only}
    1. NCT01151722. Adjuvant intravitreal bevacizumab in pars plana vitrectomy for diabetic vitreous hemorrhage. clinicaltrials.gov/show/NCT01151722 (first received 28 June 2010).
NCT01306981 {unpublished data only}
    1. NCT01306981. A prospective, randomised controlled trial of ranibizumab pre-treatment in diabetic vitrectomy - a pilot study. clinicaltrials.gov/show/NCT01306981 (first received 2 March 2011).

Additional references

Anonymous 1985
    1. Anonymous. Two-year course of visual acuity in severe proliferative diabetic retinopathy with conventional management. Diabetic Retinopathy Vitrectomy Study (DRVS) report #1. Ophthalmology 1985;92(4):492-502. - PubMed
Benson 1988
    1. Benson WE, Brown GC, Tasman W, McNamara JA. Complications of vitrectomy for non-clearing vitreous hemorrhage in diabetic patients. Ophthalmic Surgery 1988;19(12):862-4. - PubMed
Berrocal 2016
    1. Berrocal MH, Acaba LA, Acaba A. Surgery for diabetic eye complications. Current Diabetes Reports 2016;16:1-7. - PubMed
Bhende 2000
    1. Bhende M, Agraharam SG, Gopal L, Sumasri K, Sukumar B, George J, et al. Ultrasound biomicroscopy of sclerotomy sites after pars plana vitrectomy for diabetic vitreous hemorrhage. Ophthalmology 2000;107(9):1729-36. - PubMed
Blankenship 1985
    1. Blankenship GW, Machemer R. Long-term diabetic vitrectomy results. Report of 10 year follow-up. Ophthalmology 1985;92(4):503-6. - PubMed
Blankenship 1986
    1. Blankenship GW. Management of vitreous cavity hemorrhage following pars plana vitrectomy for diabetic retinopathy. Ophthalmology 1986;93(1):39-44. - PubMed
Brown 1992
    1. Brown GC, Tasman WS, Benson WE, McNamara JA, Eagle RC Jr. Reoperation following diabetic vitrectomy. Archives of Ophthalmology 1992;110(4):506-10. - PubMed
Chen 2021
    1. Chen Y, Kearns VR, Zhou L, Sandinha T, Lam WC, Steel DH, et al. Silicone oil in vitreoretinal surgery: indications, complications, new developments and alternative long-term tamponade agents. Acta Ophthalmologica 2021;99(3):240-50. - PubMed
Csaky 2008
    1. Csaky KG, Richman EA, Ferris FL. Report from the NEI/FDA Ophthalmic Clinical Trial Design and Endpoints Symposium. Investigative Ophthalmology & Visual Science 2008;49:479-89. - PubMed
de Boer 2004
    1. Boer MR, Moll AC, Vet HC, Terwee CB, Völker-Dieben HJ, Rens GH. Psychometric properties of vision-related quality of life questionnaires: a systematic review. Ophthalmic & Physiological Optics 2004;24(4):257-73. [DOI: 10.1111/j.1475-1313.2004.00187.x] - DOI - PubMed
Dervenis 2021
    1. Dervenis P, Dervenis N, Steel D, Sandinha T, Tranos P, Vasilakis P, et al. Intravitreal bevacizumab prior to vitrectomy for proliferative diabetic retinopathy: a systematic review. Therapeutic Advances in Ophthalmology 2021;13:25158414211059256. - PMC - PubMed
Dervenis 2022
    1. Dervenis N, Dervenis P, Sandinha T, Murphy DC, Steel DH. Intraocular tamponade choice with vitrectomy and internal limiting membrane peeling for idiopathic macular hole: a systematic review and meta-analysis. Ophthalmology. Retina 2022;6(6):457-68. [DOI: 10.1016/j.oret.2022.01.023] - DOI - PubMed
Diabetes UK 2020
    1. Diabetes UK. Diabetes: facts and stats. www.diabetes.org.uk/professionals/position-statements-reports/statistics... (accessed 6 June 2021).
Dziura 2013
    1. Dziura JD, Post LA, Zhao Q, Fu Z, Peduzzi P. Strategies for dealing with missing data in clinical trials: from design to analysis. Yale Journal of Biology and Medicine 2013;86(3):343-58. [PMID: ] - PMC - PubMed
El‐Sabagh 2011
    1. El-Sabagh HA, Abdelghaffar W, Labib AM, Mateo C, Hashem TM, Al-Tamimi DM, et al. Preoperative intravitreal bevacizumab use as an adjuvant to diabetic vitrectomy: histopathologic findings and clinical implications. Ophthalmology 2011;118(4):636-41. - PubMed
Faghihi 2008
    1. Faghihi H, Taheri A, Farahvash MS, Esfahani MR, Rajabi MT. Intravitreal triamcinolone acetonide injection at the end of vitrectomy for diabetic vitreous hemorrhage: a randomized, clinical trial. Retina 2008;28(9):1241-6. - PubMed
Glanville 2006
    1. Glanville JM, Lefebvre C, Miles JN, Camosso-Stefinovic J. How to identify randomized controlled trials in MEDLINE: ten years on. Journal of the Medical Library Association 2006;94(2):130-6. - PMC - PubMed
Govers 2022
    1. Govers BM, Lamers MPM, Klevering BJ, Keijser S. Air versus fluorinated gas tamponades in pars plana vitrectomy treatment for primary rhegmatogenous retinal detachment. Acta Ophthalmologica 2022;100(8):e1600-5. [DOI: 10.1111/aos.15144] - DOI - PMC - PubMed
GRADEpro GDT [Computer program]
    1. GRADEpro GDT. Hamilton (ON): McMaster University (developed by Evidence Prime), accessed 1 September 2022. Available from gradepro.org.
Gupta 2012
    1. Gupta B, Sivaprasad S, Wong R, Laidlaw A, Jackson TL, McHugh D, et al. Visual and anatomical outcomes following vitrectomy for complications of diabetic retinopathy: the DRIVE UK study. Eye 2012;26(4):510-6. - PMC - PubMed
Han 1991
    1. Han DP, Murphy ML, Mieler WF, Abrams GW. Outpatient fluid-air exchange for severe postvitrectomy diabetic vitreous hemorrhage. Long-term results and complications. Retina 1991;11(3):309-14. - PubMed
Hershberger 2004
    1. Hershberger VS, Augsburger JJ, Hutchins RK, Raymond LA, Krug S. Fibrovascular ingrowth at sclerotomy sites in vitrectomized diabetic eyes with recurrent vitreous hemorrhage: ultrasound biomicroscopy findings. Ophthalmology 2004;111(6):1215-21. - PubMed
Higgins 2017
    1. Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Churchill R, Chandler J, Cumpston MS (editors), Cochrane Handbook for Systematic Reviews of Interventions version 5.2.0 (updated June 2017), Cochrane, 2017. Available from www.training.cochrane.org/handbook.
Higgins 2021
    1. Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.2 (updated February 2021). Cochrane, 2021. Available from training.cochrane.org/handbook. - PMC - PubMed
Ho 1992
    1. Ho T, Smiddy WE, Flynn HW Jr. Vitrectomy in the management of diabetic eye disease. Survey of Ophthalmology 1992;37(3):190-202. - PubMed
Hotta 2000
    1. Hotta K, Hirakata A, Ohi Y, Yamamoto R, Shinoda K, Oshitari K, et al. Ultrasound biomicroscopy for examination of the sclerotomy site in eyes with proliferative diabetic retinopathy after vitrectomy. Retina 2000;20(1):52-8. - PubMed
Hsu 2014
    1. Hsu YR, Yang CM, Yeh PT. Clinical and histological features of epiretinal membrane after diabetic vitrectomy. Graefe's Archive for Clinical and Experimental Ophthalmology 2014;252(3):401-10. - PubMed
Hu 2019b
    1. Hu X, Pan Q, Zheng J, Song Z, Zhang Z. Reoperation following vitrectomy for diabetic vitreous hemorrhage with versus without preoperative intravitreal bevacizumab. BMC Ophthalmology 2019;19:200. - PMC - PubMed
Hutton 1980
    1. Hutton WL, Bernstein I, Fuller D. Diabetic traction retinal detachment. Factors influencing final visual acuity. Ophthalmology 1980;87:1071-7. - PubMed
Issa 2011
    1. Issa SA, Connor A, Habib M, Steel DH. Comparison of retinal breaks observed during 23 gauge transconjunctival vitrectomy versus conventional 20 gauge surgery for proliferative diabetic retinopathy. Clinical Ophthalmology 2011;2011(5):109-14. - PMC - PubMed
Jackson 2015
    1. Jackson TL, Johnston RL, Donachie PHJ, Williamson TJ, Sparrow JM, Steel DH. The Royal College of Ophthalmologists' national ophthalmology database study of vitreoretinal surgery: report 6, diabetic vitrectomy. JAMA Ophthalmology 2016;134(1):79-85. - PubMed
Joondeph 1989
    1. Joondeph BC, Blankenship GW. Hemostatic effects of air versus fluid in diabetic vitrectomy. Ophthalmology 1989;96(12):1701-6. - PubMed
Jorge 2006
    1. Jorge R, Costa RA, Calucci D, Cintra LP, Scott IU. Intravitreal bevacizumab (Avastin) for persistent new vessels in diabetic retinopathy (IBEPE study). Retina 2006;26(9):1006-13. [DOI: 10.1097/01.iae.0000246884.76018.63] - DOI - PubMed
Kaiser 2000
    1. Kaiser RS, Maguire MG, Grunwald JE, Lieb D, Jani B, Brucker AJ, et al. One-year outcomes of panretinal photocoagulation in proliferative diabetic retinopathy. American Journal of Ophthalmology 2000;129(2):178-85. - PubMed
Klein 1984a
    1. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Archives of Ophthalmology 1984;102(4):520-6. - PubMed
Klein 1984b
    1. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Archives of Ophthalmology 1984;102(4):527-32. - PubMed
Koutsandrea 2001
    1. Koutsandrea CN, Apostolopoulos MN, Chatzoulis DZ, Parikakis EA, Theodossiadis GP. Hemostatic effects of SF6 after diabetic vitrectomy for vitreous hemorrhage. Acta Ophthalmologica Scandinavica 2001;79(1):34-8. - PubMed
Kreiger 1993
    1. Kreiger AE. Wound complications in pars plana vitrectomy. Retina 1993;13(4):335-44. - PubMed
Kroll 2014
    1. Kroll P, Rodrigues EB, Meyer CH. Vitreous. New York, NY: Springer, 2014.
Laatikainen 1987
    1. Laatikainen L, Summanen P, Immonen I. Effect of tranexamic acid on postvitrectomy haemorrhage in diabetic patients. International Ophthalmology 1987;10(3):153-5. - PubMed
Liew 2014
    1. Liew G, Michaelides M, Bunce C. A comparison of the causes of blindness certifications in England and Wales in working age adults (16-64 years), 1999-2000 with 2009-2010. BMJ Open 2014;12(4):2. - PMC - PubMed
Liggett 1987
    1. Liggett PE, Lean JS, Barlow WE, Ryan SJ. Intraoperative argon endophotocoagulation for recurrent vitreous hemorrhage after vitrectomy for diabetic retinopathy. American Journal of Ophthalmology 1987;103(2):146-9. - PubMed
Mangione 2001
    1. Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD, National Eye Institute Visual Function Questionnaire Field Test Investigators. Development of the 25-item National Eye Institute Visual Function Questionnaire. Archives of Ophthalmology 2001;119(7):1050-8. [DOI: 10.1001/archopht.119.7.1050] - DOI - PubMed
Martin 1992
    1. Martin DF, McCuen BW 2nd. Efficacy of fluid-air exchange for postvitrectomy diabetic vitreous hemorrhage. American Journal of Ophthalmology 1992;114(4):457-63. - PubMed
Mason 1978
    1. Mason G, Peyman GA. The role of vitrectomy in diabetic retinopathy. International Ophthalmology Clinics 1978;18(4):133-64. - PubMed
McLeod 1991
    1. McLeod D. Microsurgical management of neovascularisation secondary to posterior segment ischaemia. Eye 1991;5(Pt 2):252-9. - PubMed
McLeod 2000
    1. McLeod D. Entry site neovascularisation after diabetic vitrectomy. British Journal of Ophthalmology 2000;84(8):810-1. - PMC - PubMed
McLeod 2003
    1. McLeod D. Wieger's ligament [republished in Ophthalmology. 2003 Jun;110(6):1265]. Ophthalmology 2003;110(4):628. - PubMed
Mehta 2020
    1. Mehta A, Rana-Rahman R, Klaassen I, Rees J, Steel DH. The effect of internal limiting membrane cleaning on epiretinal membrane formation after vitrectomy for proliferative diabetic retinopathy. Ophthalmologica 2020;243(6):426-35. - PubMed
Nagbal 2017
    1. Nagbal M, Mehrotra N, Vishnoi A. The role of perioperative anti-VEGF during vitrectomy for vitreous hemorrhage in relation to postoperative nonclearing vitreous hemorrhage and cystoid macular edema. Journal of VitreoRetinal Diseases 2017;1(6):379-84.
Novak 1984
    1. Novak MA, Rice TA, Michels RG, Auer C. Vitreous hemorrhage after vitrectomy for diabetic retinopathy. Ophthalmology 1984;91(12):1485-9. - PubMed
Packer 1989
    1. Packer AJ, McCuen BW 2nd, Hutton WL, Ramsay RC. Procoagulant effects of intraocular sodium hyaluronate (Healon) after phakic diabetic vitrectomy. A prospective, randomized study. Ophthalmology 1989;96(10):1491-4. - PubMed
Ramezani 2005
    1. Ramezani AR, Ahmadieh H, Ghaseminejad AK, Yazdani S, Golestan B. Effect of tranexamic acid on early postvitrectomy diabetic haemorrhage; a randomised clinical trial. British Journal of Ophthalmology 2005;89(8):1041-4. - PMC - PubMed
RevMan Web 2023 [Computer program]
    1. Review Manager Web (RevMan Web). Version 4.26.0. The Cochrane Collaboration, 2023. Available at revman.cochrane.org.
Rush 2022
    1. Rush RB, Velazquez JC, Rosales CR, Rush SW. Gas tamponade for the prevention of postoperative vitreous hemorrhaging after diabetic vitrectomy: a randomized clinical trial. American Journal of Ophthalmology 2022;242:173-80. [DOI: 10.1016/j.ajo.2022.06.015] - DOI - PubMed
Russo 2019
    1. Russo A, Longo A, Avitabile T, Bonfiglio V, Fallico M, Boscia F, et al. Incidence and risk factors for tractional macular detachment after anti-vascular endothelial growth factor agent pretreatment before vitrectomy for complicated proliferative diabetic retinopathy. Journal of Clinical Medicine 2019;8(11):1960. [DOI: 10.3390/jcm8111960] - DOI - PMC - PubMed
Sawa 2000
    1. Sawa H, Ikeda T, Matsumoto Y, Niiya A, Kinoshita S. Neovascularization from scleral wound as cause of vitreous rebleeding after vitrectomy for proliferative diabetic retinopathy. Japanese Journal of Ophthalmology 2000;44(2):154-60. - PubMed
Scanlon 2008
    1. Scanlon PH. The English national screening programme for sight threatening diabetic retinopathy. Journal of Medical Screening 2008;15(1):1-4. - PubMed
Schiff 2007
    1. Schiff WM, Barile GR, Hwang JC, Tseng JJ, Cekic O, Del Priore LV, et al. Diabetic vitrectomy: influence of lens status upon anatomic and visual outcomes. Ophthalmology 2007;114(3):544-50. - PubMed
Schwartz 1996
    1. Schwatz SD, Alexander R, Hiscott P, Gregor ZJ. Recognition of vitreoschisis in proliferative diabetic retinopathy. A useful landmark in vitrectomy for diabetic traction retinal detachment. Ophthalmology 1996;103(2):323-8. - PubMed
Sebag 1996
    1. Sebag J. Diabetic vitreopathy. Ophthalmology 1996;103(2):205-6. - PubMed
Steel 2008
    1. Steel DH, Habib MS, Park S, Hildreth AJ, Owen RI. Entry site neovascularization and vitreous cavity hemorrhage after diabetic vitrectomy. The predictive value of inner sclerostomy site ultrasonography. Ophthalmology 2008;115(3):525-32. - PubMed
Stefansson 2009
    1. Stefansson E. Physiology of vitreous surgery. Graefes Archives of Clinical and Experimental Ophthalmology 2009;247(2):147-63. - PubMed
Suñer 2017
    1. Suner IJ, Bressler NM, Varma R, Dolan CM, Ward J, Turpcu A. Responsiveness of the National Eye Institute Visual Function Questionnaire-25 to visual acuity gains in patients with diabetic macular edema: Evidence from the RIDE and RISE Trials. Retina 2017;37(6):1126-33. - PMC - PubMed
Tolentino 1989
    1. Tolentino FI, Cajita VN, Gancayco T, Skates S. Vitreous hemorrhage after closed vitrectomy for proliferative diabetic retinopathy. Ophthalmology 1989;96(10):1495-500. - PubMed
Vaideanu 2014
    1. Vaideanu D, Sandhu SS, Ling J, Richardson J, Steel DH. Rate of diabetic vitrectomy in a defined geographical part of North East England. Ophthalmic Epidemiology 2014;21(3):178-83. - PubMed
Veliz 2014
    1. Veliz D, Rada G. Does preoperative intravitreal bevacizumab reduce complications of vitrectomy for proliferative diabetic retinopathy? [El uso preoperatorio de bevacizumab reduce lascomplicaciones en pacientes con retinopatía diabéticasometidos a vitrectomía?]. Medwave 2014;14(11):e6052. - PubMed
Virata 2001
    1. Virata SR, Kylstra JA. Postoperative complications following vitrectomy for proliferative diabetic retinopathy with sew-on and noncontact wide-angle viewing lenses. Ophthalmic Surgery and Lasers 2001;32(3):193-7. - PubMed
West 2000
    1. West JF, Gregor ZJ. Fibrovascular ingrowth and recurrent haemorrhage following diabetic vitrectomy. British Journal of Ophthalmology 2000;84(8):822-5. - PMC - PubMed
Yang 2007
    1. Yang CM, Yeh PT, Yang CH. Intravitreal long-acting gas in the prevention of early postoperative vitreous hemorrhage in diabetic vitrectomy. Ophthalmology 2007;114(4):710-5. - PubMed
Yeh 2005
    1. Yeh PT, Yang CM, Yang CH, Huang JS. Cryotherapy of the anterior retina and sclerotomy sites in diabetic vitrectomy to prevent recurrent vitreous hemorrhage: an ultrasound biomicroscopy study. Ophthalmology 2005;112(12):2095-102. - PubMed
Yorston 2008
    1. Yorston D, Wickham L, Benson S, Bunce C, Sheard R, Charteris D. Predictive clinical features and outcomes of vitrectomy for proliferative diabetic retinopathy. British Journal of Ophthalmology 2008;92(3):365-8. - PubMed
Yoshida 2017
    1. Yoshida S, Kobayashi Y, Nakao S, Sassa Y, Hisatomi T, Ikeda Y, et al . Differential association of elevated inflammatory cytokines with postoperative fibrous proliferation and neovascularization after unsuccessful vitrectomy in eyes with proliferative diabetic retinopathy. Clinical Ophthalmology 2017;11:1697-705. - PMC - PubMed
Zhang 2013
    1. Zhang ZH, Liu HY, Hernandez-Da Mota SE, Romano MR, Falavarjani KG, Ahmadieh H, et al. Vitrectomy with or without preoperative intravitreal bevacizumab for proliferative diabetic retinopathy: a meta-analysis of randomized controlled trials. American Journal of Ophthalmology 2013;156(1):106-15. - PubMed
Zhao 2011
    1. 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. British Journal of Ophthalmology 2011;95(9):1216-22. - PMC - PubMed
Zhou 2020
    1. Zhou C, Zhang Z, Luo D, Gu C, Lahm T, Draga D, Qiu Q. A relatively higher intraocular pressure set at the end of vitrectomy is associated with a more stable and rapid visual recovery for patients with vitreous haemorrhage. Acta Ophthalmologica 2020;98(4):e428-33. [DOI: 10.1111/aos.14293] - DOI - PubMed
Zhu 2008
    1. Zhu Q, Ziemssen F, Henke-Fahle S, Tatar O, Szurman P, Aisenbrey S, et al, Tübingen Bevacizumab Study Group, Grisanti S. Vitreous levels of bevacizumab and vascular endothelial growth factor-A in patients with choroidal neovascularization. Ophthalmology 2008;115(10):1750-5. [DOI: 10.1016/j.ophtha.2008.04.023] - DOI - PubMed

References to other published versions of this review

Smith 2011
    1. Smith JM, Steel DHW. Anti-vascular endothelial growth factor for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy. Cochrane Database of Systematic Reviews 2011, Issue 5. Art. No: CD008214. [DOI: 10.1002/14651858.CD008214.pub2] - DOI - PubMed
Smith 2015
    1. Smith JM, Steel DHW. Anti-vascular endothelial growth factor for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy. Cochrane Database of Systematic Reviews 2015, Issue 8. Art. No: CD008214. [DOI: 10.1002/14651858.CD008214.pub3] - DOI - PMC - PubMed
Steel 2010
    1. Steel DHW, Smith JM. Anti-vascular endothelial growth factor for prevention of postoperative vitreous cavity haemorrhage after vitrectomy for proliferative diabetic retinopathy. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No: CD008214. [DOI: 10.1002/14651858.CD008214] - DOI

Publication types

MeSH terms

Associated data