Quiroz-Reyes Miguel A, Quiroz-Gonzalez Erick Andrés, Quiroz-Gonzalez Miguel A, Lima-Gómez Virgilio
Retina Department, Oftalmologia Integral ABC, Mexico City, Mexico.
Ophthalmology Department, Institute of Ophthalmology, Mexico City, Mexico.
Clin Ophthalmol. 2023 Aug 15;17:2359-2370. doi: 10.2147/OPTH.S419478. eCollection 2023.
This review aimed to systematically compare the efficacy and safety of intravitreal aflibercept (IVA) and vitrectomy for treating severe vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR). The review was conducted in accordance with PRISMA guidelines. A search strategy, including the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and US National Library of Medicine databases, was developed to identify randomized controlled trials (RCTs) that compared vitrectomy and IVA for managing VH due to PDR (participant age ≥ 18 years). The primary outcome measure was the difference in the mean visual acuity between the two treatment groups at 1, 6, and 24 months. Outcome measures included clearance of VH (in weeks), the incidence of recurrent VH, and the rate of complications. The studies were evaluated using the Cochrane Bias (ROB) tool. We identified 774 articles; six articles met the inclusion criteria, and two were ultimately included (n = 239 eyes). With or without PRP, IVA injections and vitrectomy were performed in 117 and 122 eyes, respectively. The mean BCVA at one month was significantly better in the vitrectomy group (MD=0.22, CI:0.10-0.34, p=0.0003), but no difference was found at six months (MD=0.04, CI: -0.04-0.12, p=0.356). The incidence of recurrent VH was significantly higher in the IVA group (OR=5.05, CI:2.71-9.42, p<0.0001). The probability of recurrent VH was five times greater in the IVA group than that in the vitrectomy group. There were no significant differences in the overall proportions of intra- or postoperative complications (OR=0.64, CI: 0.09-4.85, p=0.669). None of the studies had a low ROB in any of the seven domains. We conclude that IVA can be considered a viable treatment modality for diabetic VH in patients with a good follow-up. Vitrectomy initially provides better visual effect, faster VH recovery, and lower VH recurrence than IVA injections.
本综述旨在系统比较玻璃体内注射阿柏西普（IVA）和玻璃体切割术治疗增殖性糖尿病视网膜病变（PDR）继发严重玻璃体积血（VH）的疗效和安全性。本综述按照PRISMA指南进行。制定了检索策略，包括检索MEDLINE、Embase、Cochrane对照试验中央注册库和美国国立医学图书馆数据库，以识别比较玻璃体切割术和IVA治疗PDR所致VH（参与者年龄≥18岁）的随机对照试验（RCT）。主要结局指标是两个治疗组在1个月、6个月和24个月时平均视力的差异。结局指标包括VH清除情况（以周为单位）、复发性VH的发生率以及并发症发生率。使用Cochrane偏倚（ROB）工具对研究进行评估。我们共识别出774篇文章；6篇文章符合纳入标准，最终纳入2篇（n = 239只眼）。无论是否进行全视网膜光凝（PRP），分别对117只眼和122只眼进行了IVA注射和玻璃体切割术。玻璃体切割术组1个月时的平均最佳矫正视力（BCVA）显著更好（MD = 0.22，CI：0.10 - 0.34，p = 0.0003），但6个月时未发现差异（MD = 0.04，CI： - 0.04 - 0.12，p = 0.356）。IVA组复发性VH的发生率显著更高（OR = 5.05，CI：
