Andriolo Regis Bruni, Puga Maria Eduarda, Belfort Júnior Rubens, Atallah Alvaro Nagib
Brazilian Cochrane Center, Escola Paulista de Medicina (Unifesp-EPM), São Paulo, Brazil.
Sao Paulo Med J. 2009 May;127(2):84-91. doi: 10.1590/s1516-31802009000200006.
Many eye diseases involve increased local levels of vascular endothelial growth factor (VEGF), and there are several therapeutic strategies for them. Thus, the aim of this study was to evaluate the effectiveness and safety of bevacizumab for treating eye diseases involving increased local levels of VEGF, as the assumed pathophysiological mechanism.
The following databases were systematically searched for evidence: PubMed, CENTRAL (Cochrane Library), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) and reference lists, without language restrictions. Only randomized controlled trials were included. The primary outcome of interest was visual acuity, irrespective of the evaluation method.
A total of 667 eyes in nine randomized trials were included. Meta-analysis showed that the proportion of patients with age-related macular degeneration who presented improvements from baseline regarding best-corrected visual acuity was higher among those treated with bevacizumab than among those in the photodynamic therapy group (risk ratio, RR, 0.49; 95% confidence interval, CI, 0.31 to 0.78; P = 0.01).
The evidence available demonstrates that bevacizumab alone or combined with other treatments is more effective than other options, including photodynamic therapy, focal photocoagulation and triamcinolone. The use of bevacizumab instead of photodynamic therapy could reduce treatment costs by more than 99% and could significantly increase access to treatment. However, long-term studies are still needed in order to reduce uncertainty concerning the safety of this medication for all ocular neovascular diseases in which bevacizumab has the potential to improve visual acuity.
许多眼部疾病都伴有局部血管内皮生长因子（VEGF）水平升高，针对这些疾病有多种治疗策略。因此，本研究旨在评估贝伐单抗治疗因局部VEGF水平升高而引发的眼部疾病的有效性和安全性，这是假定的病理生理机制。
系统检索了以下数据库以获取证据：PubMed、CENTRAL（Cochrane图书馆）、拉丁美洲和加勒比健康科学文献数据库（Lilacs）以及参考文献列表，无语言限制。仅纳入随机对照试验。感兴趣的主要结局是视力，无论评估方法如何。
九项随机试验共纳入667只眼。荟萃分析表明，在年龄相关性黄斑变性患者中，接受贝伐单抗治疗的患者从基线最佳矫正视力改善的比例高于光动力治疗组（风险比，RR，0.49；95%置信区间，CI，0.31至0.78；P = 0.01）。
现有证据表明，单独使用贝伐单抗或与其他治疗联合使用比其他选择更有效，包括光动力疗法、局部光凝和曲安奈德。使用贝伐单抗而非光动力疗法可使治疗成本降低99%以上，并可显著增加治疗可及性。然而，仍需要进行长期研究，以减少关于这种药物对所有贝伐单抗有可能改善视力的眼部新生血管疾病安全性的不确定性。
