Li Jianqing, Xu Jiayi, Chen Yiyi, Zhang Jiaju, Cao Yihong, Lu Peirong
Department of Ophthalmology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China.
J Ophthalmol. 2018 Oct 23;2018:1425707. doi: 10.1155/2018/1425707. eCollection 2018.
Intravitreal antivascular endothelial growth factor (anti-VEGF) therapy has been widely used for the treatment of neovascularization (NV) secondary to age-related macular degeneration (AMD). This study aimed to compare the efficacy among different subtypes of neovascular age-related macular degeneration (nAMD).
PubMed, Embase, and the Cochrane Library were searched for eligible studies. We performed meta-analysis using Review Manager 5.3 and Stata/SE 12.0.
A total of 24 studies met our inclusion criteria and were included in the systematic review. At 3 months, the mean logarithm of the minimum angle of resolution (logMAR) improvements were -0.09, -0.18, and -0.23 for type 1, 2, and 3, respectively, while the mean macular thickness (MT) changes were -104.83, -130.76, and -196.29 m. At 12 months, the mean changes in Early Treatment of Diabetic Retinopathy Study (ETDRS) letters were 6.38, 8.12, and 9.37, while the MT decrease was 126.51, 126.52, and 139.85 m, respectively. However, statistically significant difference was only found between type 1 and 3 in vision improvement, both in the short term (=0.0002) and long term (=0.01).
The reactivity to VEGF inhibitors varied among different subtypes of nAMD. The efficacy of intravitreal anti-VEGF therapy in type 3 nAMD was statistically better than type 1 when considering vision improvement at 3 and 12 months. Thus, the lesion subtype is a predictor for the treatment outcome which can help guide prognosis.
玻璃体内抗血管内皮生长因子（抗VEGF）疗法已广泛用于治疗年龄相关性黄斑变性（AMD）继发的新生血管形成（NV）。本研究旨在比较不同亚型的新生血管性年龄相关性黄斑变性（nAMD）之间的疗效。
检索PubMed、Embase和Cochrane图书馆以获取符合条件的研究。我们使用Review Manager 5.3和Stata/SE 12.0进行荟萃分析。
共有24项研究符合我们的纳入标准并被纳入系统评价。在3个月时，1型、2型和3型的最小分辨角对数（logMAR）改善均值分别为-0.09、-0.18和-0.23，而黄斑平均厚度（MT）变化分别为-104.83、-130.76和-196.29μm。在12个月时，糖尿病视网膜病变早期治疗研究（ETDRS）字母数的平均变化分别为6.38、8.12和9.37，而MT降低分别为126.51、126.52和139.85μm。然而，仅在视力改善方面，1型和3型在短期（=0.0002）和长期（=0.01）均存在统计学显著差异。
不同亚型的nAMD对VEGF抑制剂的反应性不同。在考虑3个月和12个月时的视力改善情况时，玻璃体内抗VEGF疗法在3型nAMD中的疗效在统计学上优于1型。因此，病变亚型是治疗结果的预测指标，有助于指导预后。
