Anti-vascular endothelial growth factor for neovascular age-related macular degeneration (Review)

Background-Nearsightedness (myopia) causes blurry vision when looking at distant objects. Highly nearsighted people are at greater risk of several vision-threatening problems such as retinal detachments, choroidal atrophy, cataracts and glaucoma. Interventions that have been explored to slow the progression of myopia include bifocal spectacles, cycloplegic drops, intraocular pressurelowering drugs, muscarinic receptor antagonists and contact lenses. The purpose of this review was to systematically assess the effectiveness of strategies to control progression of myopia in children. Objectives-To assess the effects of several types of interventions, including eye drops, undercorrection of nearsightedness, multifocal spectacles and contact lenses, on the progression of nearsightedness in myopic children younger than 18 years. We compared the interventions of interest with each other, to single vision lenses (SVLs) (spectacles), placebo or no treatment. Search methods-We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register

Istotność kontroli krótkowzroczności jest związana z rosnącym odsetkiem światowej populacji obarczonej tą wadą wzroku, a jest ona jednym z czynników ryzyka wystąpienia innych chorób oczu. W licznych pracach poddawano analizie wpływ różnych metod optycznych i farmakologicznych na spowolnienie progresji krótkowzroczności. Stosowano zarówno korekcję okularową i soczewkami kontaktowymi o konstrukcjach dwu-i wieloogniskowych, jak i ortokeratologię. Wśród leków badano przede wszystkim wpływ różnych stężeń atropiny na zahamowanie progresji krótkowzroczności. Rzadziej opisywano zastosowanie innych leków, np. pirenzepiny. Za najbardziej skuteczne metody, powodujące największe spowolnienie zwiększania się krótkowzroczności, uznano zastosowanie soczewek kontaktowych modyfikujących obwodowe rozogniskowanie, soczewek ortokeratologicznych oraz użycie atropiny, przede wszystkim w niskich stężeniach. W licznych opracowaniach podkreślono też szkodliwy -przyspieszający narastanie krótkowzroczności -wpływ niedokorygowania. Podnosi się też możliwy hamujący wpływ na progresję tej wady refrakcji czasu spędzanego na zewnątrz pomieszczeń, czyli na świeżym powietrzu. Aby osiągnąć sukces w kontroli krótkowzroczności, należy wcześnie wykryć wadę, skorygować ją w pełni i zastosować najbardziej skuteczne metody zahamowania jej progresji.

Analysis 1.17. Comparison 1 Anti-VEGF treatment versus control, Outcome 17 Mean change in quality of life scores at 1 year...... Analysis 1.18. Comparison 1 Anti-VEGF treatment versus control, Outcome 18 Mean change in quality of life scores at 2 years..... Analysis 2.1. Comparison 2 Bevacizumab versus ranibizumab, Outcome 1 Gain of 15 or more letters visual acuity at 1 year........ Analysis 2.2. Comparison 2 Bevacizumab versus ranibizumab, Outcome 2 Gain of 15 or more letters visual acuity at 2 years....... Analysis 2.3. Comparison 2 Bevacizumab versus ranibizumab, Outcome 3 Loss of fewer than 15 letters visual acuity at 1 year...... Analysis 2.4. Comparison 2 Bevacizumab versus ranibizumab, Outcome 4 Loss of fewer than 15 letters visual acuity at 2 years..... Analysis 2.5. Comparison 2 Bevacizumab versus ranibizumab, Outcome 5 Visual acuity better than 20/200

BACKGROUND: Diabetic retinopathy is a common complication of diabetes and a leading cause of visual impairment and blindness. Research has established the importance of blood glucose control to prevent development and progression of the ocular complications of diabetes. Simultaneous blood pressure control has been advocated for the same purpose, but findings reported from individual studies have supported varying conclusions regarding the ocular benefit of interventions on blood pressure. OBJECTIVES: The primary aim of this review was to summarize the existing evidence regarding the effect of interventions to control or reduce blood pressure levels among diabetics on incidence and progression of diabetic retinopathy, preservation of visual acuity, adverse events, quality of life, and costs. A secondary aim was to compare classes of antihypertensive medications with respect to the same outcomes. METHODS:Search methods: We searched a number of electronic databases including CENTRAL as well as ongoing trial registries. We last searched the electronic databases on 25 April 2014. We also reviewed reference lists of review articles and trial reports selected for inclusion. In addition, we contacted investigators of trials with potentially pertinent data. Selection criteria: We included in this review randomized controlled trials (RCTs) in which either type 1 or type 2 diabetic participants, with or without hypertension, were assigned randomly to intense versus less intense blood pressure control, to blood pressure control versus usual care or no intervention on blood pressure, or to different classes of antihypertensive agents versus placebo. Data collection and analysis: Pairs of review authors independently reviewed titles and abstracts from electronic and manual searches and the full text of any document that appeared to be relevant. We assessed included trials independently for risk of bias with respect to outcomes reported in this review. We extracted data regarding trial characteristics, incidence and progression of retinopathy, visual acuity, quality of life, and cost-effectiveness at annual intervals after study entry whenever provided in published reports and other documents available from included trials. MAIN RESULTS: We included 15 RCTs, conducted primarily in North America and Europe, that had enrolled 4157 type 1 and 9512 type 2 diabetic participants, ranging from 16 to 2130 participants in individual trials. In 10 of the 15 RCTs, one group of participants was assigned to one or more anti-hypertensive agents and the control group received placebo. In three trials, intense blood pressure control was compared to less intense blood pressure control. In the remaining two trials, blood pressure control was compared with usual care. Five of the 15 trials enrolled type 1 diabetics, and 10 trials enrolled type 2 diabetics. Six trials were sponsored