Intravitreal anti-VEGF injections for treating wet age-related macular degeneration: a systematic review and meta-analysis

Abstract

AimsAge-related macular degeneration (AMD) is the main cause of blindness. Anti-vascular endothelial growth factor is used to prevent further neovascularization due to wet AMD. The purpose of this systematic review was to investigate the effect and protocol of anti-vascular endothelial growth factor treatment on wet AMD.MethodsA comprehensive literature search was performed in PubMed, Embase, the Cochrane Library, CNKI, and reference lists. Meta-analysis was performed using Stata12.0 software, best corrected visual acuity (BCVA), retinal thickness, and lesion size were evaluated.ResultsTwelve randomized controlled trials spanning from 2010 to 2014 and involving 5,225 patients were included. A significant difference was observed between the intravitreal ranibizumab (IVR) group and the intravitreal bevacizumab group (standard mean difference =−0.14, 95% confidence interval [CI] =−0.23 to −0.05). No significant differences were observed in best corrected VA, retinal thickness, or lesion size between IVR and the intravitreal aflibercept group. Compared to monthly injection, IVR as-needed injections (PRN) can raise VA by 1.97 letters (weighted mean difference =1.97, 95% CI =0.14–3.794). Combination therapy of IVR and photodynamic therapy can significantly raise VA by 2.74 letters when combined with IVR monotherapy (weighted mean difference =2.74, 95% CI =0.26–5.21).ConclusionThe superiority remains unclear between IVR and intravitreal bevacizumab in the treatment of neovascular AMD. Intravitreal aflibercept dosed every 2 months required fewer injection times, but produced similar efficacy as monthly IVR. IVR PRN could significantly increase VA. Combined with photodynamic therapy, IVR therapy could also increase VA effectively.

Anti-vascular endothelial growth factor for neovascular age-related macular degeneration: a meta-analysis of randomized controlled trials

“…Current available data on adverse effects suggest that the safety profile of aflibercept is comparable with that of ranibizumab, however the number of patients who experienced adverse events was small, leading to imprecise estimates of effect sizes. These results are similar to previous meta-analyses on this topic [ 4 , 5 , 20 , 29 – 31 , 41 ].…”

“…To the author’s knowledge, existing meta-analyses of randomized controlled trials (RCTs) comparing the efficacy and safety of anti-VEGF agents in patients with nAMD, have included up to 12 trials in their comparisons [ 4 , 5 , 20 , 29 – 31 ]. Such meta-analyses have been limited to the types of anti-VEGF agents evaluated.…”

Up-regulation of pro-angiogenic pathways and induction of neovascularization by an acute retinal light damage

“…The common feature of all the retinal diseases involving abnormal neovascularization, such as nAMD, is the up-regulation of VEGF. In fact many drugs for nAMD treatment, so far, have been developed with the aim of targeting VEGF 31 . Therefore, the first step to investigate vascular-related events was the analysis of the VEGF protein level.…”

An update on inflammatory choroidal neovascularization: epidemiology, multimodal imaging, and management

“…Patients with AMD develop CNV due to various contributory factors such as inflammation, complement dysregulation, and growth factor drives such as VEGF drive. Therefore, patients with AMD require constant suppression of VEGF with multiple injections of anti-VEGF agents [ 24 , 25 ]. In contrast, in patients with i-CNV, with control of inflammation, which primarily drives the development of the CNV, it may be possible that the neovascular drive is extinguished once the inflammation is adequately controlled.…”