School of Public Health & School of Nursing, Yangzhou University (J.Z., Y.L., C.L., W.W., H.Z.), Yangzhou, China; Clinical College of Chinese Medicine, Gansu University of Chinese Medicine (J.Z., X.L.), Lanzhou, China; Department of Ophthalmology, Gansu Provincial Hospital of TCM (J.Z., X.L.), Lanzhou, China.
School of Medicine, Yangzhou University (Y.Y., C.L.), Yangzhou, China.
Am J Ophthalmol. 2024 Jul;263:141-151. doi: 10.1016/j.ajo.2024.02.038. Epub 2024 Mar 6.
This study aims to appraise the therapeutic effectiveness of intravitreal injections anti-vascular endothelial growth factor (anti-VEGF) vs alternative therapies in managing radiation retinopathy (RR).
Systematic review and meta-analysis.
We obtained comprehensive data retrieval using PubMed, Embase, Web of Science, Scopus, and the Cochrane Library from their inception until December 15, 2023. This review included randomized controlled trials (RCTs) and nonrandomized studies (NRSs) reporting on best-corrected visual acuity (BCVA) among RR patients treated with intravitreal anti-VEGF. Study selection and data extraction were meticulously performed by 2 independent reviewers. The Cochrane Risk of Bias Tool 2.0 (RoB 2.0) and Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) scales were utilized for bias risk assessment. Quantification of heterogeneity was executed using Q, H, and I statistics. The primary endpoint was the BCVA at the final observation point of each study. Secondary endpoints included central retinal thickness (CRT), foveal avascular zone (FAZ) area, and capillary density (CD) at the level of superficial capillary plexus. Subgroup analyses were undertaken to explore potential heterogeneity sources possibly due to treatment duration and study design. Sensitivity analyses were conducted to ascertain result stability.
This analysis incorporated 7 studies (including 3 RCTs) encompassing 922 patients afflicted with RR. Relative to other treatment modalities, intravitreal anti-VEGF therapy was associated with a statistically significant mean decrease in BCVA of -0.34 logMAR (95% CI, -0.39 to -0.30 logMAR; I = 87.70%; P < .001), and a substantial reduction in CRT of -34.65 µm (95% CI, -50.70 to -18.60 µm; I = 30.40%; P < .001). Additionally, a reduction in the FAZ area by -0.69 mm² (95% CI, -0.91 to -0.46 mm², I = 0%; P < .001) was observed. A positive tendency was noted in CD at the superficial capillary plexus between anti-VEGF and other therapeutic interventions.
Intravitreal anti-VEGF injections, in comparison to other treatments, demonstrate superior efficacy in enhancing BCVA and reducing CRT, thereby underscoring the potential of anti-VEGF in ameliorating radiation retinopathy outcomes. However, the conclusions are constrained by the incorporation of data from some NRSs and the small sample sizes.
本研究旨在评估玻璃体内注射抗血管内皮生长因子（anti-VEGF）与其他疗法在治疗放射性视网膜病变（RR）中的疗效。
系统评价和荟萃分析。
我们通过 PubMed、Embase、Web of Science、Scopus 和 Cochrane 图书馆从其成立到 2023 年 12 月 15 日进行了全面的数据检索。本综述纳入了比较 RR 患者接受玻璃体内抗 VEGF 治疗后最佳矫正视力（BCVA）的随机对照试验（RCT）和非随机研究（NRS）。由 2 名独立评审员仔细进行研究选择和数据提取。使用 Cochrane 偏倚风险工具 2.0（RoB 2.0）和干预非随机研究的偏倚风险（ROBINS-I）量表评估偏倚风险。使用 Q、H 和 I 统计量评估异质性。主要终点是每个研究的最终观察点的 BCVA。次要终点包括中央视网膜厚度（CRT）、中心无血管区（FAZ）面积和浅层毛细血管丛的毛细血管密度（CD）。进行亚组分析以探索可能由于治疗持续时间和研究设计引起的潜在异质性来源。进行敏感性分析以确定结果的稳定性。
该分析纳入了 7 项研究（包括 3 项 RCT），共纳入 922 例 RR 患者。与其他治疗方法相比，玻璃体内抗 VEGF 治疗与 BCVA 的平均下降有统计学意义，为 -0.34 logMAR（95%CI，-0.39 至-0.30 logMAR；I = 87.70%；P <.001），以及 CRT 显著降低 -34.65 µm（95%CI，-50.70 至-18.60 µm；I = 30.40%；P <.001）。还观察到 FAZ 面积减少 -0.69 mm²（95%CI，-0.91 至-0.46 mm²，I = 0%；P <.001）。抗 VEGF 与其他治疗干预措施相比，浅层毛细血管丛的 CD 呈阳性趋势。
与其他治疗方法相比，玻璃体内抗 VEGF 注射在提高 BCVA 和降低 CRT 方面显示出更好的疗效，这表明抗 VEGF 在改善放射性视网膜病变结果方面具有潜力。然而，由于纳入了一些 NRS 的数据以及样本量较小，因此结论受到限制。
