Clinical effectiveness analysis of anti-VEGF for central retinal vein occlusion associated with macular edema : A Meta-analysis / 中华实验眼科杂志

ABSTRACT

Background Central retinal vein occlusion (CRVO) causes macular edema.The treatment options are limited.There have been a series of randomized controlled trials (RCTs) to investigate the effectiveness of anti-vascular endothelial growth factor (VEGF),but the systematic review of the literature to assess the strength of evidence supporting the interventions is lack.Objective This study was to evaluate the effectiveness of anti-VEGF therapy for improving vision and reducing macular edema in patients with CRVO associated with macular edema.Methods A systematic review and Meta-analysis was performed.According to guidelines of Cochrane collaboration,the literature of RCTs for anti-VEGF therapy treating CRVO with macular edema was searched from Cochrane Library,Pubmed,Embase,Wanfang databases and conference documents without the limiting of language or date.The literature was screened independently by two searchers,and the methodology quality of the included papers was estimated.The proportion of patients with the best corrected visual acuity (BCVA) ≥ 15 ETDRS letters,the change ranges of BCVA (LogMAR) and central fovea thickness (CFT) were analyzed.The overall effect size was analyzed using Review Manager 5.1 in The Cochrane Collaboration as weighted mean difference (WSD).Fixed effect mode was used to evaluate and compare the treating effectiveness between the anti-VEGF group and sham treating group.Results Six RCTs were incorporated with 948 eyes and generated 3 comparisons in the study,including 5 multi-central studies and 1 single central study.Pegaptanib was administered in 1 study,and ranibizumab was used in 2 studied,bevacizumab in 1 study and VEGF Trap-Eye in 2 studies.The results demonstrated that anti-VEGF therapy resulted in more patients who gained 15 ETDRS letters or more during one-year duration (Z =8.43,P＜0.000 01) in the 6th month after intravitreous injection.BCVA logMAR was significantly improved in the anti-VEGF therapy group in comparison with sham treating group during the initial 6 months of trial (Z=28.27,P＜0.000 01) with the maximal difference in the 6th month.CFT value was significantly lower in the anti-VEGF therapy group than that of the sham treating group during the first 6 months (Z=35.38,P＜0.000 01) in the 3rd month.Topical adverse events occurred occasionally,including vitreous hemorrhage in 19 eyes,cataract in 16 eyes,endophthalmitis in 8 eyes and iris neovascularization in 2 eyes.No system adverse event was found after administration of the drugs.Conclusions Anti-VEGF therapy is efficient in CRVO with macular edema with little side effect.However,in order to maintain the effect,multiple injections are needed.Early onset treatment of anti-VEGF drugs is recommended,but the delayed onset is still beneficial.