COMPARE COMBINED USE OF ANTI-VEGF DRUGS DURING OR AFTER PARS PLANA VITRECTOMY FOR DIABETIC MACULAR EDEMA GUIDED BY MICROSCOPE-INTEGRATED OPTICAL COHERENCE TOMOGRAPHY.

Abstract

This study used microscope-integrated optical coherence tomography (MIOCT) to identify patients with proliferative diabetic retinopathy with concurrent diabetic macular edema (DME) during vitrectomy and compared the efficacy of immediate versus delayed anti-VEGF treatment, as well as ranibizumab versus conbercept. A prospective randomized controlled trial was conducted on patients with proliferative diabetic retinopathy undergoing pars plana vitrectomy (PPV). Patients with preoperatively unconfirmed DME were evaluated intraoperatively using MIOCT. Those with MIOCT-confirmed DME were randomly assigned to three groups: Group A received intravitreal ranibizumab during PPV with additional injections at 1 and 2 months postoperatively. Group B received intravitreal conbercept during PPV with additional injections at 1 and 2 months postoperatively. Group C received ranibizumab at 1, 2, and 3 months postoperatively. All groups followed a 3+ PRN protocol. Best-corrected visual acuity and central macular thickness were measured at 1 day; 1 week; 1, 3, and 6 months post-PPV. A total of 115 eyes from 115 patients with proliferative diabetic retinopathy (one eye per patient) with MIOCT-confirmed concurrent DME during PPV were enrolled and randomly assigned to treatment groups. Six eyes were lost to follow-up, and 109 eyes (94.8%) completed the entire 6-month study. Groups A and B showed significant best-corrected visual acuity and central macular thickness improvements compared with Group C throughout the follow-up period, with Group B demonstrating superior early and sustained efficacy. Immediate anti-VEGF treatment during PPV, particularly with conbercept, was associated with reduced complications and accelerated recovery of visual function. In patients with proliferative diabetic retinopathy with MIOCT-identified DME during vitrectomy, immediate anti-VEGF treatment provides superior best-corrected visual acuity and central macular thickness improvements compared with delayed treatment, with conbercept demonstrating better efficacy.