Zhang Bowen, Dong Xingmei, Sun Yi
Department of Operating Room, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Pathology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
Front Med (Lausanne). 2023 May 23;10:1166957. doi: 10.3389/fmed.2023.1166957. eCollection 2023.
To further evaluate the efficacy and safety of anti-vascular endothelial growth factor (VEGF) agents in management of primary pterygium.
Randomized controlled trials (RCTs) in databases of PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to September 2022. Recurrences and complications were evaluated as the pooled risk ratio (RR) and 95% confidence interval (CI) using random-effects model.
In total of 1,096 eyes in 19 RCTs were included. Anti-VEGF agents statistically decreased recurrence rate of pterygium following surgery (RR 0.47, 95% CI 0.31-0.74, < 0.001). Subgroup analysis showed that anti-VEGF as an adjunct to bare sclera (RR 0.34, 95% CI 0.13-0.90, = 0.03) and conjunctival autograft (RR 0.50, 95% CI 0.26-0.96, = 0.04) statistically reduced recurrence rate, while the effect was not favorable for conjunctivo-limbo autograft (RR 0.99, 95% CI 0.36-2.68, = 0.98). Anti-VEGF agents statistically decreased recurrence in White patients (RR 0.48, 95% CI 0.28-0.83, = 0.008), while didn't in Yellow patients (RR 0.43, 95% CI 0.12-1.47, = 0.18). Both topical (RR 0.19, 95% CI 0.08-0.45, < 0.001) and subconjunctival anti-VEGF agents (RR 0.64, 95% CI 0.45-0.91, = 0.01) had a positive influence on recurrence. There was no statistically significant difference in complications between the groups (RR 0.80, 95% CI 0.52-1.22, = 0.29).
As adjuvant treatment, anti-VEGF agents statistically reduced the recurrence following pterygium surgery, especially among White patients. Anti-VEGF agents were well tolerated without increased complications.
进一步评估抗血管内皮生长因子（VEGF）药物治疗原发性翼状胬肉的疗效和安全性。
检索PubMed、Web of Science、Embase数据库以及Cochrane对照试验中央注册库中从建库至2022年9月的随机对照试验（RCT）。采用随机效应模型将复发率和并发症评估为合并风险比（RR）及95%置信区间（CI）。
共纳入19项RCT中的1096只眼。抗VEGF药物在统计学上降低了翼状胬肉术后的复发率（RR 0.47，95%CI 0.31 - 0.74，P < 0.001）。亚组分析显示，抗VEGF药物作为单纯巩膜术（RR 0.34，95%CI 0.13 - 0.90，P = 0.03）和结膜自体移植术（RR 0.50，95%CI 0.26 - 0.96，P = 0.04）的辅助治疗，在统计学上降低了复发率，而对结膜-角膜缘自体移植术效果不佳（RR 0.99，95%CI 0.36 - 2.68，P = 0.98）。抗VEGF药物在统计学上降低了白人患者的复发率（RR 0.48，95%CI 0.28 - 0.83，P = 0.008），而对黄种人患者无此效果（RR 0.43，95%CI 0.12 - 1.47，P = 0.18）。局部应用（RR 0.19，95%CI 0.08 - 0.45，P < 0.001）和结膜下注射抗VEGF药物（RR 0.64，95%CI 0.45 - 0.91，P = 0.01）对复发均有积极影响。两组间并发症无统计学显著差异（RR 0.80，95%CI 0.52 - 1.22，P = 0.29）。
作为辅助治疗，抗VEGF药物在统计学上降低了翼状胬肉术后的复发率，尤其是在白人患者中。抗VEGF药物耐受性良好，且未增加并发症。
