Liu Xiang-Dong, Zhou Xiao-Dong, Wang Zhi, Shen Hong-Jie
Department of Ophthalmology, Affiliated Jinshan Hospital, Fudan University, Shanghai 201508, China.
Int J Ophthalmol. 2014 Dec 18;7(6):1048-55. doi: 10.3980/j.issn.2222-3959.2014.06.26. eCollection 2014.
To further evaluate the efficacy and safety of intravitreal bevacizumab (IVB) versus macular photocoagulation (MPC) in treatment of diabetic macular edema (DME) by Meta-analysis.
Pertinent publications were identified through systemic searches of PubMed, Medline, EMBASE, and the Cochrane Controlled Trials Register up to 30 November, 2013. Changes in central macular thickness (CMT) in µm and best-corrected visual acuity (BCVA) in logMAR equivalents were extracted at 1, 3, 6, 12 and 24mo after initial treatment, and a Meta-analysis was carried out to compare results between groups receiving IVB and MPC.
Five randomized controlled trial (RCTs) and one high-quality comparative study were identified and included. Our Meta-analysis revealed that both IVB and MPC resulted in the improvements of CMT and BCVA in eyes with DME at 1mo after initial treatment, with IVB being significantly superior to MPC (P=0.01 and 0.02, respectively). The improvements of both measure outcomes at 3, 6, 12 and 24mo after treatment did not vary significantly between the IVB groups and MPC groups (CMT at 3mo, P=0.85; at 6mo, P=0.29; at 12mo, P=0.56; at 24mo, P=0.71; BCVA at 3mo, P=0.31; at 6mo, P= 0.30; at 12mo, P=0.23; at 24mo, P=0.52). However, the number of observed adverse events was low in all studies.
Current evidence shows IVB treatment trends to be more effective in improvements of macular edema and vision in eyes with DME at an earlier follow up (1mo) compared with MPC. At other time, both interventions have comparable efficacy without statistical significances.
通过Meta分析进一步评估玻璃体内注射贝伐单抗（IVB）与黄斑光凝（MPC）治疗糖尿病性黄斑水肿（DME）的疗效和安全性。
通过系统检索截至2013年11月30日的PubMed、Medline、EMBASE和Cochrane对照试验注册库来确定相关出版物。在初始治疗后1、3、6、12和24个月提取中心黄斑厚度（CMT，单位为微米）和最佳矫正视力（BCVA，以logMAR等效值表示）的变化，并进行Meta分析以比较接受IVB和MPC治疗组的结果。
确定并纳入了5项随机对照试验（RCT）和1项高质量的比较研究。我们的Meta分析显示，IVB和MPC在初始治疗后1个月均能改善DME患者眼的CMT和BCVA，IVB明显优于MPC（分别为P = 0.01和0.02）。治疗后3、6、12和24个月两组测量结果的改善在IVB组和MPC组之间无显著差异（3个月时CMT，P = 0.85；6个月时，P = 0.29；12个月时，P = 0.56；24个月时，P = 0.71；3个月时BCVA，P = 0.31；6个月时，P = 0.30；12个月时，P = 0.23；24个月时，P = 0.52）。然而，所有研究中观察到的不良事件数量较少。
目前的证据表明，与MPC相比，IVB治疗在早期随访（1个月）时改善DME患者眼的黄斑水肿和视力方面更有效。在其他时间，两种干预措施具有相当的疗效，无统计学意义。
