文献类型：期刊文献

英文题名：Comparison of the efficacy and safety of drug therapies for macular edema secondary to central retinal vein occlusion

作者：Qian, Tianwei[1];Zhao, Mengya[1];Wan, Yongjing[2];Li, MengXiao[2];Xu, Xun[1]

机构：[1]Shanghai Jiao Tong Univ, Shanghai Gen Hosp, Dept Ophthalmol, Sch Med,Shanghai Key Lab Ocular Fundus Dis, Shanghai, Peoples R China;[2]East China Univ Sci & Technol, Sch Informat Sci & Engn, Shanghai, Peoples R China

年份：2018

卷号：8

期号：12

外文期刊名：BMJ OPEN

收录：;WOS:【SCI-EXPANDED(收录号:WOS:000455309300060)】；

基金：This study was funded by the National Natural Science Foundation of China (Grant No. 81800878) and Interdisciplinary Program of Shanghai Jiao Tong University (Grant No. YG2017QN24).

语种：英文

摘要：Objectives To evaluate the efficacy and safety of anti-vascular endothelial growth factor (VEGF) agents and corticosteroids for the treatment of macular oedema (ME) secondary to central retinal vein occlusion (CRVO). Design Systematic review and network meta-analysis. Participants Patients from previously reported randomised controlled trials (RCTs) comparing anti-VEGF and corticosteroids for the treatment of ME secondary to CRVO. Methods Literature searches were conducted using PubMed, Medline, Embase, Cochrane Library and clinicaltrials.gov until March 2017. Therapeutic effects were estimated using the proportions of patients gaining/losing >= 15 letters, best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Treatment safety was estimated using the proportions of adverse events, namely increased intraocular pressure (IOP), cataracts, vitreous haemorrhage (VH) and retinal tear. The software ADDIS (V.1.16.8) was used for analysis. Treatment effect and safety of different drugs could be ranked based on simulation. Results Eleven RCTs comprising 2060 patients were identified. Regarding patients gaining >= 15 letters, aflibercept and ranibizumab were significantly more effective than sham/placebo at 6 months. Regarding patients losing >= 15 letters at 6 months, ranibizumab showed significant improvement compared with dexamethasone. Aflibercept, bevacizumab or ranibizumab showed greater improvements in BCVA than sham/placebo at 6 months. Intravitreal ranibizumab injection demonstrated greater CRT reduction than both sham and dexamethasone did. Dexamethasone had a higher risk of increased IOP than aflibercept and ranibizumab. Ranibizumab demonstrated a greater risk of cataracts than dexamethasone. Aflibercept and ranibizumab demonstrated low incidence of VH and retinal tear, respectively. Aflibercept had a slight advantage over ranibizumab as assessed by benefit-risk analysis. Conclusions Anti-VEGF agents have advantages in the treatment of ME secondary to CRVO. Aflibercept and ranibizumab showed marked BCVA improvement and CRT reduction. Aflibercept may have a slight advantage over ranibizumab. The results of this study can serve as a reference for clinicians to provide patient-tailored treatment.