Comparison between anti-VEGF therapy and corticosteroid or laser therapy for macular oedema secondary to retinal vein occlusion: A meta-analysis

Abstract

SummaryWhat is known and objective: Therapeutic effects of anti-VEGF agents, corticosteroids and laser therapy have been previously examined for treating macular oedema secondary to branch and central retinal vein occlusion (BRVO and CRVO). However, anti-VEGF efficacy has not been previously compared to corticosteroid or laser therapy efficacy. We performed a meta-analysis to compare these treatments.Methods: Pertinent publications were identified through comprehensive literature searches. Therapeutic effects were estimated using best-corrected visual acuity central retinal thickness (CRT) and intraocular pressure (IOP). The ReviewManager (version 5.3.5) was used to perform searches. Results and discussion: Eleven randomized, controlled trials that included 1045RVO patients were identified. For eyes with BRVO, anti-VEGF therapy improved BCVA significantly more than corticosteroid/laser therapy at 3 (P=.0002), 6 (P<.00001) and 12 months (P<.00001). For eyes with CRVO, this difference was only significant at 6 months (P=.002). The same was true when efficacy was examined using CRT at 3 and 6 months (BRVO: both P<.00001, CRVO 6 months: P=.02). Long-term efficacy of anti-VEGF agents was limited in eyes with BRVO and CRVO.Improvements in BCVA were similar at 1 and 3 months (P=.74), but BCVA decreased between 3 and 6 months (P=.03). In contrast, BCVA progressively decreased 1 and 6 months following corticosteroid/laser therapy (both P<.00001). Lastly, eyes that had been treated with anti-VEGF agents had significantly lower IOP changes than eyes treated with corticosteroids/laser 3 and 6 months after initiating therapy (both P<.00001).What is new and conclusion: Anti-VEGF agents improve BCVA and reduce CRT more effectively and longer than corticosteroid/laser in eyes with RVO. Anti-VEGF agents also have a lower risk of elevating IOP. Additionally, anti-VEGF agents are more effective for treating BRVO than CRVO. K E Y W O R D Santi-VEGF, dexamethasone, laser photocoagulation, retinal vein occlusion, triamcinoloneThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Comparative efficacy of bevacizumab, ranibizumab, and aflibercept for treatment of macular edema secondary to retinal vein occlusion: a systematic review and network meta-analysis

“…Qian and colleagues [5] pooled data from 11 RCTs and directly compared the efficacy of intravitreal anti-VEGF therapy to intravitreal triamcinolone acetate/dexamethasone or laser therapy. They found that anti-VEGF treatment was more efficacious than the corticosteroids or laser therapy.…”

“…Baseline BCVA and CMT, duration of RVO, subtypes of RVO, the degree of severity and macula involvement, different OCT devices, and the total number of injections might have an impact on treatment outcomes across studies [5,12,13,19,32] as well as the required re-injection of the drugs during the PRN regimen. An initial CMT might affect the mean decrease in CMT in each treatment group.…”

“…First, this review did not include unpublished data. However, we could not retrieve additional unpublished data suggested by the previous systematic reviews and metaanalyses [5,12]. Second, we did not address variation across RCTs in certain key eligibility criteria.…”

“…Apart from grid laser photocoagulation for BRVO treatment and panretinal photocoagulation for both CRVO and BRVO treatment, intravitreal corticosteroids have been used to treat macular edema secondary to RVO but they are likely to increase the risk of cataract progression and intraocular pressure elevation [5][6][7]. Recently, anti-vascular endothelial growth factor (VEGF) therapy has become the treatment of choice for this ocular disorder.…”

“…Ford and colleagues summarized that anti-VEGF drugs and triamcinolone were effective for these patients but they could not perform meta-analysis due to lack of head-to-head trials [6]. More recent systematic reviews and meta-analyses did not show relative efficacy of individual anti-VEGF drug [5]. Another network metaanalysis excluded bevacizumab which has been widely used off-label in clinical practice, from the quantitative analysis [12].…”