Comparison between anti-VEGF therapy and corticosteroid or laser therapy for macular oedema secondary to retinal vein occlusion: A meta-analysis

作者：Qian, T.; Zhao, M.; Xu, X.^*

来源：Journal of Clinical Pharmacy and Therapeutics, 2017, 42(5): 519-529.

DOI：10.1111/jcpt.12551

• anti-VEGF
• dexamethasone
• laser photocoagulation
• retinal vein occlusion
• triamcinolone

What is known and objectiveTherapeutic effects of anti-VEGF agents, corticosteroids and laser therapy have been previously examined for treating macular oedema secondary to branch and central retinal vein occlusion (BRVO and CRVO). However, anti-VEGF efficacy has not been previously compared to corticosteroid or laser therapy efficacy. We performed a meta-analysis to compare these treatments. @@@ MethodsPertinent publications were identified through comprehensive literature searches. Therapeutic effects were estimated using best-corrected visual acuity (BCVA), central retinal thickness (CRT) and intraocular pressure (IOP). The Review Manager (version 5.3.5) was used to perform searches. @@@ Results and discussionEleven randomized, controlled trials that included 1045 RVO patients were identified. For eyes with BRVO, anti-VEGF therapy improved BCVA significantly more than corticosteroid/laser therapy at 3 (P=.0002), 6 (P<.00001) and 12months (P<.00001). For eyes with CRVO, this difference was only significant at 6months (P=.002). The same was true when efficacy was examined using CRT at 3 and 6months (BRVO: both P<.00001, CRVO 6months: P=.02). Long-term efficacy of anti-VEGF agents was limited in eyes with BRVO and CRVO. Improvements in BCVA were similar at 1 and 3months (P=.74), but BCVA decreased between 3 and 6months (P=.03). In contrast, BCVA progressively decreased 1 and 6months following corticosteroid/laser therapy (both P<.00001). Lastly, eyes that had been treated with anti-VEGF agents had significantly lower IOP changes than eyes treated with corticosteroids/laser 3 and 6months after initiating therapy (both P<.00001). @@@ What is new and conclusionAnti-VEGF agents improve BCVA and reduce CRT more effectively and longer than corticosteroid/laser in eyes with RVO. Anti-VEGF agents also have a lower risk of elevating IOP. Additionally, anti-VEGF agents are more effective for treating BRVO than CRVO.

• 出版日期2017-10
• 单位上海交通大学