Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee.
Ophthalmology. 2017 Sep;124(9):1412-1423. doi: 10.1016/j.ophtha.2017.03.060. Epub 2017 May 24.
To evaluate the available evidence on the ocular safety and efficacy of current therapeutic alternatives for the management of macular edema (ME) secondary to branch retinal vein occlusion (BRVO).
Literature searches were last conducted on January 31, 2017, in PubMed with no date restrictions and limited to articles published in English, and in the Cochrane Database without language limitations. The searches yielded 321 citations, of which 109 were reviewed in full text and 27 were deemed appropriate for inclusion in this assessment. The panel methodologist assigned ratings to the selected studies according to the level of evidence.
Level I evidence was identified in 10 articles that addressed anti-vascular endothelial growth factor (VEGF) pharmacotherapies for ME, including intravitreal bevacizumab (5), aflibercept (2), and ranibizumab (4). Level I evidence was identified in 6 studies that examined intravitreal corticosteroids, including triamcinolone (4) and the dexamethasone implant (2). Level I evidence also was available for the role of macular grid laser photocoagulation (7) and scatter peripheral laser surgery (1). The inclusion of level II and level III studies was limited given the preponderance of level I studies. The number of studies on combination therapy is limited.
Current level I evidence suggests that intravitreal pharmacotherapy with anti-VEGF agents is effective and safe for ME secondary to BRVO. Prolonged delay in treatment is associated with less improvement in visual acuity (VA). Level I evidence also indicates that intravitreal corticosteroids are effective and safe for the management of ME associated with BRVO; however, corticosteroids are associated with increased potential ocular side effects (e.g., elevated intraocular pressure, cataracts). Laser photocoagulation remains a safe and effective therapy, but VA results lag behind the results for anti-VEGF therapies.
评估现有治疗选择对治疗分支静脉阻塞（BRVO）继发黄斑水肿（ME）的眼部安全性和疗效的证据。
文献检索于 2017 年 1 月 31 日在 PubMed 进行，无时间限制，仅限于发表的英文文章，并在 Cochrane 数据库中进行，无语言限制。检索产生了 321 条引文，其中 109 条全文审查，27 条被认为适合纳入本评估。小组方法学家根据证据水平对选定的研究进行评分。
确定了 10 篇评估 ME 抗血管内皮生长因子（VEGF）药物治疗的 I 级证据文章，包括玻璃体内贝伐单抗（5 篇）、阿柏西普（2 篇）和雷珠单抗（4 篇）。6 篇评估玻璃体内皮质类固醇治疗的文章确定为 I 级证据，包括曲安奈德（4 篇）和地塞米松植入物（2 篇）。黄斑格栅激光光凝（7 篇）和散在周边激光手术（1 篇）也有 I 级证据。鉴于 I 级研究居多，纳入的 II 级和 III 级研究有限。联合治疗的研究数量有限。
目前的 I 级证据表明，玻璃体内抗 VEGF 药物治疗 BRVO 继发 ME 是有效且安全的。治疗延迟时间延长与视力（VA）改善程度降低相关。I 级证据还表明，玻璃体内皮质类固醇治疗 BRVO 相关 ME 是有效且安全的；然而，皮质类固醇与增加潜在眼部副作用（如眼压升高、白内障）相关。激光光凝仍然是一种安全有效的治疗方法，但 VA 结果落后于抗 VEGF 治疗。
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