治疗近视性脉络膜新生血管的不同方法：一项网状Meta分析。
Different approaches for treating myopic choroidal neovascularization: a network Meta-analysis.
作者信息
Wu Ya-Jun, Feng Yu-Liang, Yang Jia-Song, Fan Hua, Li Wen-Sheng
机构信息
Aier School of Ophthalmology, Central South University, Changsha 410000, Hunan Province, China.
Department of Ophthalmology, Shanghai Aier Eye Hospital, Shanghai 200235, China.
出版信息
Int J Ophthalmol. 2023 Dec 18;16(12):2105-2116. doi: 10.18240/ijo.2023.12.25. eCollection 2023.
AIM
To evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), photodynamic therapy (PDT), and laser treatment (LT) for anatomical and functional improvement in myopic choroidal neovascularization (mCNV) patients.
METHODS
Two researchers independently searched PubMed, Cochrane Library, Web of Science, and other databases to screen studies comparing best-corrected vision acuity (BCVA) and foveal center thickness (FCT) changes after mCNV treatment. Post-treatment chorioretinal atrophy (CRA) is a secondary outcome indicator. The retrieval time limit is from the database construction to January 30, 2023.
RESULTS
A total of 1072 eyes in 16 articles were included. In the RCTs, intravitreal bevacizumab (IVB) and intravitreal ranibizumab (IVR) were superior to PDT (MD=0.18, 95%CI: 0.02, 0.40, MD=0.18, 95%CI: 0.01, 0.42) in improving BCVA of mCNV patients (<0.05). The relative effectiveness in improving BCVA, from high to low, appeared to be IVR, intravitreal aflibercept (IVA), IVB, LT, PDT, and sham first followed by IVA (Sham/IVA). While improving the FCT from high to low was IVA, IVR, IVB, PDT. In retrospective studies, the results of BCVA after long-term treatment showed that all the therapeutic effects from high to low was IVA, intravitreal conbercept (IVC), IVR, IVB, IVB/IVR, PDT with IVB/IVR, PDT. The effect of improving FCT was IVA, IVR, IVC, PDT, and IVB from high to low. And in the effects of improving CRA, the IVB appeared to be higher than IVR, while the PDT was the smallest, but none of the differences in the results were statistically significant.
CONCLUSION
Anti-VEGF has the best effect on long-term vision improvement in mCNV patients, using IVB or IVR alone to treat mCNV may be better than IVB or IVR combined with PDT. There is no significant difference in the improvement of visual acuity, macular edema, and CRA in mCNV patients treated with any different anti-VEGF drugs.
目的
评估玻璃体内注射抗血管内皮生长因子（anti-VEGF）、光动力疗法（PDT）和激光治疗（LT）对近视性脉络膜新生血管（mCNV）患者解剖结构和功能改善的疗效。
方法
两名研究人员独立检索PubMed、Cochrane图书馆、Web of Science及其他数据库，以筛选比较mCNV治疗后最佳矫正视力（BCVA）和黄斑中心厚度（FCT）变化的研究。治疗后脉络膜视网膜萎缩（CRA）为次要结局指标。检索时间范围为从各数据库建库至2023年1月30日。
结果
共纳入16篇文章中的1072只眼。在随机对照试验（RCTs）中，玻璃体内注射贝伐单抗（IVB）和玻璃体内注射雷珠单抗（IVR）在改善mCNV患者的BCVA方面优于PDT（MD = 0.18，95%CI：0.02，0.40；MD = 0.18，95%CI：0.01，0.42）（P<0.05）。改善BCVA的相对有效性从高到低依次为IVR、玻璃体内注射阿柏西普（IVA）、IVB、LT、PDT、假手术，其次是IVA（假手术/IVA）。而改善FCT从高到低依次为IVA、IVR、IVB、PDT。在回顾性研究中，长期治疗后BCVA的结果显示，所有治疗效果从高到低依次为IVA、玻璃体内注射康柏西普（IVC）、IVR、IVB、IVB/IVR、联合IVB/IVR的PDT、PDT。改善FCT的效果从高到低依次为IVA、IVR、IVC、PDT、IVB。在改善CRA的效果方面，IVB似乎高于IVR，而PDT最小，但结果差异均无统计学意义。
结论
抗VEGF对mCNV患者的长期视力改善效果最佳，单独使用IVB或IVR治疗mCNV可能优于IVB或IVR联合PDT。使用任何不同抗VEGF药物治疗mCNV患者，在视力、黄斑水肿和CRA改善方面均无显著差异。
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