Qian T, Zhao M, Xu X
Shanghai Key Laboratory of Ocular Fundus Diseases, Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
J Clin Pharm Ther. 2017 Oct;42(5):519-529. doi: 10.1111/jcpt.12551. Epub 2017 Jun 22.
Therapeutic 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.
Pertinent 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.
Eleven 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 12 months (P<.00001). For eyes with CRVO, this difference was only significant at 6 months (P=.002). The same was true when efficacy was examined using CRT at 3 and 6 months (BRVO: both P<.00001, CRVO 6 months: 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 3 months (P=.74), but BCVA decreased between 3 and 6 months (P=.03). In contrast, BCVA progressively decreased 1 and 6 months 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 6 months after initiating therapy (both P<.00001).
Anti-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.
抗血管内皮生长因子（VEGF）药物、皮质类固醇和激光疗法治疗视网膜分支静脉阻塞（BRVO）和视网膜中央静脉阻塞（CRVO）继发黄斑水肿的疗效此前已得到研究。然而，此前尚未对抗VEGF药物的疗效与皮质类固醇或激光疗法的疗效进行比较。我们进行了一项荟萃分析以比较这些治疗方法。
通过全面的文献检索确定相关出版物。使用最佳矫正视力（BCVA）、视网膜中央厚度（CRT）和眼压（IOP）评估治疗效果。使用Review Manager（5.3.5版）进行检索。
共纳入11项随机对照试验，涉及1045例RVO患者。对于BRVO患者的眼睛，抗VEGF疗法在3个月（P = 0.0002）、6个月（P < 0.00001）和12个月（P < 0.00001）时改善BCVA的效果显著优于皮质类固醇/激光疗法。对于CRVO患者的眼睛，这种差异仅在6个月时显著（P = 0.002）。在3个月和6个月时使用CRT评估疗效时情况相同（BRVO：均P < 0.00001，CRVO 6个月：P = 0.02）。抗VEGF药物对BRVO和CRVO患者眼睛的长期疗效有限。BCVA在1个月和3个月时的改善相似（P = 0.74），但在3个月至6个月之间下降（P = 0.03）。相比之下，皮质类固醇/激光疗法后1个月至6个月BCVA逐渐下降（均P < 0.00001）。最后，在开始治疗3个月和6个月后，接受抗VEGF药物治疗的眼睛的IOP变化显著低于接受皮质类固醇/激光治疗的眼睛（均P < 0.00001）。
在RVO患者的眼睛中，抗VEGF药物比皮质类固醇/激光疗法更有效、更持久地改善BCVA并降低CRT。抗VEGF药物还具有较低的IOP升高风险。此外，抗VEGF药物治疗BRVO比CRVO更有效。
