Gao Shuang, Lin Zhongjing, Shen Xi
Department of Ophthalmology, Ruijin Hospital Affiliated Shanghai Jiaotong University School of Medicine, Shanghai, China.
Front Pharmacol. 2020 Jun 5;11:849. doi: 10.3389/fphar.2020.00849. eCollection 2020.
To compare anti-vascular growth factor (anti-VEGF) pharmacotherapy with pan-retinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR).
PubMed, Embase, Medline, the ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials were reviewed systemically. Randomized controlled trials (RCT) on anti-VEGF therapy versus PRP or anti-VEGF agent combined with PRP versus PRP for PDR are eligible to be included. Outcome measures were regression and recurrence of neovascularization, change in best corrected vision acuity, development of vitreous hemorrhage, and need for vitrectomy. A meta-analysis was conducted using RevMan (Cochrane Collaboration, Oxford, United Kingdom).
Twelve RCTs with a total of 1026 eyes were identified. The meta-analysis results showed that regression of neovascularization did not vary significantly among different treatment regimens (P=0.06), whereas the recurrence of new vessels was significantly lower in PRP monotherapy (P < 0.00001). The best corrected visual acuity was significantly improved with anti-VEGF monotherapy or in the combined group than in the PRP groups (P < 0.00001, P=0.04, respectively). Odds ratio for post-treatment vitreous hemorrhage and vitrectomy rate between anti-VEGF therapy and PRP were 0.65 (95% confidence interval, 0.45-0.95; P = 0.03), and 0.24 (95% confidence interval, 0.12-0.48; P < 0.0001).
Our meta-analysis indicates that anti-VEGF pharmacotherapy is associated with superior visual acuity outcomes and less PDR-related complications. However, there is insufficient evidence to suggest anti-VEGF therapy as an alternative to PRP.
比较抗血管生长因子（抗VEGF）药物治疗与全视网膜光凝（PRP）治疗增殖性糖尿病视网膜病变（PDR）的效果。
系统检索PubMed、Embase、Medline、ClinicalTrials.gov和Cochrane对照试验中心注册库。纳入比较抗VEGF治疗与PRP或抗VEGF药物联合PRP与PRP治疗PDR的随机对照试验（RCT）。观察指标为新生血管的消退和复发、最佳矫正视力的变化、玻璃体出血的发生情况以及玻璃体切割术的需求。使用RevMan（英国牛津Cochrane协作网）进行荟萃分析。
共纳入12项RCT，涉及1026只眼。荟萃分析结果显示，不同治疗方案之间新生血管的消退差异无统计学意义（P = 0.06），而PRP单一疗法中新血管的复发率显著更低（P < 0.00001）。抗VEGF单一疗法或联合治疗组的最佳矫正视力改善程度显著优于PRP组（分别为P < 0.00001，P = 0.04）。抗VEGF治疗与PRP治疗后玻璃体出血的比值比及玻璃体切割术率分别为0.65（95%置信区间，0.45 - 0.95；P = 0.03）和0.24（95%置信区间，0.12 - 0.48；P < 0.0001）。
我们的荟萃分析表明，抗VEGF药物治疗具有更好的视力预后且PDR相关并发症更少。然而，尚无足够证据表明抗VEGF治疗可替代PRP。
