Background: Since the efficacy of ranibizumab (RBZ), bevacizumab (BVZ) and aflibercept (AFB) is comparable in neovascular age-related macular degeneration (AMD), we conducted a systematic review and meta-analysis to evaluate the long-term safety profiles of these agents, including ocular safety. Methods: Systematic review identifying randomized controlled trials (RCTs) comparing RBZ, BVZ and AFB directly published before March 2019. Serious ocular adverse events (SOAE) of special interest were endophthalmitis, pseudo-endophthalmitis, retinal pigment epithelium tear and newly identified macular atrophy. Results: Thirteen RCTs selected for meta-analysis (4952 patients, 8723 people-years follow-up): 10 compared RBZ vs. BVZ and three RBZ vs. AFB. There were no significant differences in almost all adverse events (systemic and ocular) between BVZ, RBZ and AFB in up to two years’ follow-up. Macular atrophy was reported heterogeneously and not reported as SOAE in most trials. Conclusions: Direct comparison of RBZ, BVZ and AFB safety profiles in the RCT network meta-analytical setting have not revealed a consistent benefit of these three commonly used anti-vascular endothelial growth factor (anti-VEGF) agents in AMD. Network model ranking highlighted potential benefits of RBZ in terms of a systemic safety profile; however, this appears a hypothesis rather than a conclusion. Newly identified macular atrophy is underestimated in RCTs—future real-world data should be focused on SOAE.
With account to the increase in the elderly population in most of the developed countries, the WHO defines age-related macular degeneration (AMD) as one of the main causes of blindness in the world. A large percentage of disability is accounted for by exudative, or neovascular, form of AMD. Today, a total of 5 anti-VEGF drugs exist that are recommended for treatment of exudative AMD: pegaptanib, ranibizumab, bevacizumab, aflibercept, and conbercept. Despite significant progress in the treatment of neovascular AMD yielded by the introduction into clinical practice of anti-VEGF drugs, some patients report a lack (down to complete lack) of response with standard treatment patterns and even a decrease in treatment efficacy after repeated intravitreal injections.
Considering an upward global trend in cardiovascular disease rates, retinal vein occlusion (RVO) in particular, development of therapeutic guidelines is a pressing issue in ophthalmology. Risk factors for RVO include hypertension, atherosclerosis, diabetes mellitus, blood disorders, inflammatory disorders, and prescription drug use. Three stages of RVO have been identified. By location, the entity can be divided into three big groups: central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and hemicentral retinal vein occlusion (HCRVO), each being either ischemic or nonischemic. Functional prognosis is better in nonischemic occlusions. Patient management comprises acute-stage treatment (anticoagulants, fibrinolytic agents, and hemodilution) and struggling with ocular complications (intravitreal injections and laser coagulation). It is essential that primary assessment and follow-up of patients at any stage of RVO include optical coherence tomography and fluorescent angiography.
Возрастная макулярная дегенерация (ВМД) -заболевание сетчатки, ассоциированное с возрастом, поражающее макулу и приводящее к ухудшению центрального зрения. Географическую атрофию (ГА) характеризуют как позднюю стадию ВМД. ГА представляет собой потерю участков ретинального пигментного эпителия (РПЭ), необходимого для поддержания нормального функционирования сетчатки за счет транспорта питательных элементов и ионов, выработки ростовых факторов и защиты от фотоокисления. Учитывая анализ литературы, ГА при ВМД можно подразделить на следующие подтипы: ассоциированную с друзами; ассоциированную с хориоидальной неоваскуляризацией; после анти-VEGF-терапии; в результате коллапса отслойки РПЭ и после разрыва РПЭ. При сравнении полученных функциональных результатов различных исследований можно сказать одно, что наличие ГА у пациентов с экссудативной ВМД не может считаться противопоказанием для проведения анти-VEGF-терапии, однако данные пациенты требуют более тщательного мониторирования с использованием высокотехнологичных методов визуализации глазного дна и персонализированного подхода при выборе схем лечения.
Ключевые слова: макулярная дегенерация, географическая атрофия, анти-VEGF-терапия, ранибизумаб, бевацизумаб, афлиберцепт, сетчатка.Age-related macular degeneration (AMD) is a retinal disease associated with older age; it affects macula and leads to deterioration of central vision. Geographic atrophy (GA) is described as advanced stage AMD. Essentially, GA is the loss of some areas of retinal pigment epithelium (RPE), which is necessary for normal functioning of the retina as it transports nutrients and ions, helps with production of growth factors and protects from photo-oxidation. Based on literature data, GA in AMD can be subtyped as follows: drusen-related; associated with choroidal neovascularization; secondary to anti-VEGF treatment; subsequent to collapse of RPE detachment and RPE rupture. Comparison of functional results of various examination methods suggests that presence of GA in patients with exudative AMD cannot be a counter-indication for anti-VEGF therapy, but these patients require careful monitoring involving high-technology methods of eye fundus visualization and personalized approach when choosing the treatment regimen.
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