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抗血管内皮生长因子(VEGF)治疗糖尿病性黄斑水肿、静脉阻塞相关性黄斑水肿和新生血管性年龄相关性黄斑变性的疗效:一项系统评价

Outcomes of Anti-VEGF Therapy in Eyes with Diabetic Macular Edema, Vein Occlusion-Related Macular Edema, and Neovascular Age-Related Macular Degeneration: A Systematic Review.

作者信息

Aldokhail Laila Salah, Alhadlaq Abdulaziz Mohammad, Alaradi Lujain Mohamed, Alaradi Lamees Mohamed, AlShaikh Fatimah Yaseen

机构信息

Department of Ophthalmology, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.

Division of Ophthalmology, Security Forces Hospital, Riyadh, Saudi Arabia, Ophthalmology Department, College of Medicine, Qassim university, Qassim, Saudi Arabia.

出版信息

Clin Ophthalmol. 2024 Dec 17;18:3837-3851. doi: 10.2147/OPTH.S489114. eCollection 2024.

Abstract

BACKGROUND

Anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionized the management of various ocular conditions, including diabetic macular edema (DME), retinal vein occlusion (RVO)-related macular edema (ME), and neovascular age-related macular degeneration (nAMD). However, there remains a need to systematically assess its effectiveness across these distinct conditions.

METHODOLOGY

A systematic review was conducted to identify studies evaluating the efficacy of anti-VEGF therapy in improving ocular outcomes in patients with DME, RVO-related ME, and nAMD. PubMed, Embase, and Cochrane Library databases were searched for relevant articles published up to 2024. Studies meeting the inclusion criteria were critically appraised, and data on the proportion of patients gaining ≥15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters in best-corrected visual acuity (BCVA), mean change in BCVA (ETDRS letters), and reduction in central macular thickness (CMT) (μm) were extracted and synthesized.

RESULTS

The systematic review identified 18 studies comprising randomized controlled trials, prospective studies, retrospective analyses, and observational studies. Anti-VEGF therapy demonstrated efficacy across all three conditions, with varying proportions of patients experiencing improvements in BCVA and reductions in CMT. Notably, the proportion of patients gaining ≥15 ETDRS letters ranged from 18.1% to 44.8% in DME, while mean changes in BCVA ranged from +4.2 letters to +21.4 letters in RVO-related ME and nAMD. Reductions in CMT ranged from 183.1 μm to 294 μm in DME and RVO-related ME.

CONCLUSION

Anti-VEGF therapy represents a cornerstone in the management of DME, RVO-related ME, and nAMD, with significant improvements observed in BCVA and reductions in CMT across diverse patient populations. While our findings support the effectiveness of anti-VEGF therapy in improving ocular outcomes, further research is warranted to compare its efficacy with alternative treatment modalities and to elucidate its long-term safety profile.

摘要

背景

抗血管内皮生长因子(anti-VEGF)疗法彻底改变了包括糖尿病性黄斑水肿(DME)、视网膜静脉阻塞(RVO)相关黄斑水肿(ME)和新生血管性年龄相关性黄斑变性(nAMD)在内的各种眼部疾病的治疗方式。然而,仍需要系统地评估其在这些不同疾病中的有效性。

方法

进行了一项系统评价,以确定评估抗VEGF疗法改善DME、RVO相关ME和nAMD患者眼部结局疗效的研究。检索了PubMed、Embase和Cochrane图书馆数据库中截至2024年发表的相关文章。对符合纳入标准的研究进行严格评估,并提取和综合关于最佳矫正视力(BCVA)提高≥15个早期糖尿病视网膜病变研究(ETDRS)字母的患者比例、BCVA的平均变化(ETDRS字母)以及中心黄斑厚度(CMT)降低(μm)的数据。

结果

该系统评价确定了18项研究,包括随机对照试验、前瞻性研究、回顾性分析和观察性研究。抗VEGF疗法在所有三种疾病中均显示出疗效,不同比例的患者BCVA得到改善,CMT降低。值得注意的是,DME患者中获得≥15个ETDRS字母的比例在18.1%至44.8%之间,而RVO相关ME和nAMD患者的BCVA平均变化在+4.2字母至+21.4字母之间。DME和RVO相关ME患者的CMT降低范围在183.1μm至294μm之间。

结论

抗VEGF疗法是DME、RVO相关ME和nAMD治疗的基石,在不同患者群体中BCVA有显著改善,CMT降低。虽然我们的研究结果支持抗VEGF疗法改善眼部结局的有效性,但仍有必要进一步研究将其疗效与其他治疗方式进行比较,并阐明其长期安全性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/82f9/11663998/95f3c03433ce/OPTH-18-3837-g0001.jpg

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本文引用的文献

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