抗VEGF注射与手术治疗年龄相关性黄斑变性相关黄斑下出血的疗效与安全性：一项系统评价和Meta分析

Efficacy and Safety of Anti-VEGF Injections and Surgery for Age-Related Macular Degeneration-Related Submacular Hemorrhage: A Systematic Review and Meta-Analysis.

作者信息

Shaheen Abdulla, Mehra Divy, Ghalibafan Seyyedehfatemeh, Patel Shivam, Buali Fatima, Panneerselvam Sugi, Perez Nathalie, Hoyek Sandra, Flynn Harry W, Patel Nimesh, Yannuzzi Nicolas A

机构信息

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.

Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

出版信息

Ophthalmol Retina. 2025 Jan;9(1):4-12. doi: 10.1016/j.oret.2024.07.024. Epub 2024 Aug 3.

DOI:10.1016/j.oret.2024.07.024

PMID:39098637

Abstract

TOPIC

This systematic review and meta-analysis investigates the efficacy and safety of anti-VEGF injections compared with surgical intervention in improving visual acuity (VA) and reducing complications for patients with submacular hemorrhage (SMH) due to neovascular age-related macular degeneration (AMD).

CLINICAL RELEVANCE

Determining the optimal intervention for SMH in AMD is crucial for patient care.

METHODS

We included studies on anti-VEGF injections or surgical interventions for SMH in AMD from 7 databases, searched up to May 2024. Data extraction and quality assessment were done by 2 independent reviewers. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analysis employed random-effects models. Primary outcomes were pooled mean logarithm of the minimum angle of resolution VA difference (initial examination minus last follow-up VA) and adverse events rates.

RESULTS

A total of 43 observational studies were included: 21 (960 eyes) on anti-VEGF and 22 (455 eyes) on surgery. Comparisons were made across separate studies due to lack of head-to-head studies. Meta-analysis included 11 anti-VEGF studies (444 eyes) and 12 surgical studies (195 eyes) for VA outcomes. The mean difference in VA was -0.16 (95% confidence interval (CI), -0.24 to -0.08) for anti-VEGF and -0.36 (95% CI, -0.68 to -0.04) for surgery, with no significant difference between groups (chi-square = 1.70, df = 1, P = 0.19). Heterogeneity was high in surgical studies (I = 96.2%, τ = 0.23, P < 0.01) and negligible in anti-VEGF studies (I = 7%, τ = 0.003, P = 0.38). The GRADE certainty was moderate for anti-VEGF and low for surgery. Anti-VEGF had lower rates of cataract (0% vs. 4.6%), proliferative vitreoretinopathy (0.1% vs. 2.0%), and retinal detachment (0.1% vs. 10.6%), but similar rates of recurrent hemorrhage (5.4% vs. 5.3%). Complications were summarized descriptively due to zero-cell problem.

CONCLUSION

Both anti-VEGF and surgery treat SMH in AMD with similar VA outcomes but different safety profiles. Anti-VEGF is preferred for less severe hemorrhage, whereas surgery is suited for extensive hemorrhage. Despite uncertain comparative VA outcomes, treatment should be guided by clinical judgment and patient factors.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

摘要

主题

本系统评价和荟萃分析旨在研究抗血管内皮生长因子（VEGF）注射与手术干预相比，在改善新生血管性年龄相关性黄斑变性（AMD）所致黄斑下出血（SMH）患者的视力（VA）及减少并发症方面的疗效和安全性。

临床意义

确定AMD中SMH的最佳干预措施对患者护理至关重要。

方法

我们纳入了截至2024年5月从7个数据库检索到的关于AMD中SMH的抗VEGF注射或手术干预的研究。数据提取和质量评估由2名独立 reviewers 完成。使用推荐分级、评估、制定和评价（GRADE）方法评估证据的确定性。荟萃分析采用随机效应模型。主要结局为最小分辨角VA差异（初始检查减去末次随访VA）的合并平均对数和不良事件发生率。

结果

共纳入43项观察性研究：21项（960只眼）关于抗VEGF，22项（455只眼）关于手术。由于缺乏头对头研究，在不同研究间进行了比较。荟萃分析纳入了11项抗VEGF研究（444只眼）和12项手术研究（195只眼）用于VA结局。抗VEGF组的VA平均差异为-0.16（95%置信区间（CI），-0.24至-0.08），手术组为-0.36（95%CI，-0.68至-0.04），两组间无显著差异（卡方=1.70，自由度=1，P=0.19）。手术研究中的异质性较高（I=96.2%，τ=0.23，P<0.01），抗VEGF研究中的异质性可忽略不计（I=7%，τ=0.003，P=0.38）。抗VEGF的GRADE确定性为中等，手术的为低。抗VEGF的白内障发生率（0%对4.6%）、增殖性玻璃体视网膜病变发生率（0.1%对2.0%）和视网膜脱离发生率（0.1%对10.6%）较低，但复发性出血发生率相似（5.4%对5.3%）。由于零单元格问题，对并发症进行了描述性总结。