Proyecto Epistemonikos, Santiago, Chile; Departamento de Oftalmología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Departamento de Oftalmología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Servicio de Neonatología, Clínica Alemana, Santiago, Chile.
Medwave. 2022 Jan 17;22(1):e8507. doi: 10.5867/medwave.2022.01.8507.
Retinopathy of prematurity (ROP) is a condition that affects preterm infants, being the second leading cause of childhood blindness worldwide. The most commonly used treatments are cryotherapy or laser photocoagulation, but over the last few years, anti-vascular endothelial growth factor (anti-VEGF) drugs have gradually gained more adherents, mainly in the treatment of patients with type 1 retinopathy of prematurity (ET- ROP) Therefore, it is important to summarize the existing evidence to evaluate the efficacy and safety of anti-VEGF drugs in type 1 retinopathy of prematurity.
We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach.
We identified six systematic reviews including 15 studies overall, of which five were randomized trials. We conclude that the use of anti-VEGF compared to laser photocoagulation, probably reduces the risk of refractive errors. On the other hand, the use of anti-VEGF may result in little or no difference in the mortality at hospital discharge, lens or corneal opacity requiring surgery, and complete or partial retinal detachment, but the certainty of the evidence is low. Finally, it is not possible to clearly establish whether anti-VEGF compared with laser photocoagulation, increases the recurrence of retinopathy of prematurity, because the certainty of the existing evidence has been assessed as very low.
早产儿视网膜病变（ROP）是一种影响早产儿的疾病，是全球儿童失明的第二大主要原因。最常用的治疗方法是冷冻疗法或激光光凝术，但在过去几年中，抗血管内皮生长因子（anti-VEGF）药物逐渐得到更多的认可，主要用于治疗 1 型早产儿视网膜病变（ET-ROP）。因此，总结现有证据评估抗 VEGF 药物在 1 型早产儿视网膜病变中的疗效和安全性非常重要。
我们在 Epistemonikos 中进行了搜索，这是一个最大的健康系统评价数据库，通过筛选多个信息来源（包括 MEDLINE、EMBASE、Cochrane 等）进行维护。我们从系统评价中提取数据，重新分析原始研究的数据，进行荟萃分析，并使用 GRADE 方法生成发现摘要表。
我们确定了 6 项系统评价，共纳入 15 项研究，其中 5 项为随机试验。我们的结论是，与激光光凝术相比，使用抗 VEGF 可能会降低屈光不正的风险。另一方面，使用抗 VEGF 可能对出院时的死亡率、需要手术的晶状体或角膜混浊、完全或部分视网膜脱离没有或几乎没有差异，但证据的确定性较低。最后，由于现有证据的确定性被评估为非常低，因此无法明确确定与激光光凝术相比，抗 VEGF 是否会增加早产儿视网膜病变的复发率。
