Faculty of Medicine, McGill University, Montreal, QC, Canada.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Eye (Lond). 2022 Dec;36(12):2271-2278. doi: 10.1038/s41433-021-01833-2. Epub 2021 Nov 24.
BACKGROUND/OBJECTIVES: This meta-analysis investigates the efficacy and safety of intravitreal anti-VEGF injections (IVI) compared to combination laser photocoagulation and IVI (LPC-IVI) in treating macular oedema secondary to retinal vein occlusion (RVO).
SUBJECTS/METHODS: A literature search of MEDLINE, EMBASE and Cochrane CENTRAL was conducted from inception until March 2021. Randomized controlled trials that reported relevant efficacy and/or safety parameters following LPC-IVI relative to IVI were included. Meta-analysis was conducted with a random effects model. The primary outcome was best-corrected visual acuity (BCVA), while secondary outcomes were central macular thickness (CMT), central retinal thickness (CRT), central subfield thickness (CST), number of IVIs received, and incidence of adverse events.
A total of 10 studies were included, for which 362 eyes were randomized to LPC-IVI and 365 to IVI. In comparing macular laser photocoagulation with IVI (MLP-IVI) in BRVO patients, no significant differences were seen in final BCVA (p = 0.78) or change in BCVA (p = 0.09) after treatment. Similarly, no significant differences were seen in final CMT (p = 0.54), change in CMT (p = 0.33), final CRT (p = 0.90), change in CRT (p = 0.97), or number of injections required (p = 0.78). The same results were seen in subgroup analyses for macular laser without peripheral laser in BRVO and CRVO patients. Consistent results were observed when considering peripheral LPC-IVI to IVI in BRVO and CRVO.
No significant differences were seen between combination MLP-IVI or peripheral LPC-IVI relative to IVI monotherapy for final BCVA or OCT parameters in macular oedema secondary to RVO.
背景/目的：本荟萃分析调查了玻璃体内抗血管内皮生长因子注射（IVI）与联合激光光凝和 IVI（LPC-IVI）治疗视网膜静脉阻塞（RVO）继发黄斑水肿的疗效和安全性。
受试者/方法：从建库到 2021 年 3 月，对 MEDLINE、EMBASE 和 Cochrane CENTRAL 进行了文献检索。纳入了报告 LPC-IVI 与 IVI 治疗后相关疗效和/或安全性参数的随机对照试验。采用随机效应模型进行荟萃分析。主要结局为最佳矫正视力（BCVA），次要结局为黄斑中心厚度（CMT）、中心视网膜厚度（CRT）、中心区视网膜厚度（CST）、接受 IVI 的次数和不良事件的发生率。
共纳入 10 项研究，其中 362 只眼随机分配至 LPC-IVI 组，365 只眼随机分配至 IVI 组。在 BRVO 患者中比较黄斑激光光凝与 IVI（MLP-IVI）时，治疗后最终 BCVA（p=0.78）或 BCVA 变化（p=0.09）无显著差异。同样，最终 CMT（p=0.54）、CMT 变化（p=0.33）、最终 CRT（p=0.90）、CRT 变化（p=0.97）或所需注射次数（p=0.78）也无显著差异。在 BRVO 和 CRVO 患者中，黄斑无周边激光的黄斑激光亚组分析中也观察到了相同的结果。在 BRVO 和 CRVO 患者中，当考虑周边 LPC-IVI 与 IVI 时，也观察到了一致的结果。
在 RVO 继发黄斑水肿中，与 IVI 单药治疗相比，联合 MLP-IVI 或周边 LPC-IVI 治疗后最终 BCVA 或 OCT 参数无显著差异。
