首选玻璃体腔注射贝伐单抗或曲安奈德对比治疗视网膜中央静脉阻塞继发黄斑水肿疗效及安全性差异的荟萃分析

Comparison of efficacy and complications in treatment of macular edema secondary to central retinal vein occlusion by intravitreal bevacizumab with intravitreal triamcinolone acetonide for first priority: a meta-analysis

目的综合评价首选玻璃体腔注射贝伐单抗(IVB)或曲安奈德(IVT)对比治疗视网膜中央静脉阻塞(CRVO)继发黄斑水肿时的疗效与安全性的差异。设计荟萃分析。研究对象Medline(1966~2012年)、EMbase(1966~2011年)、Cochrane图书馆(2011年)及中国生物医学文献数据库CBM(1979~2011年)有关贝伐单抗或曲安奈德对比治疗CRVO继发黄斑水肿的临床对照研究文献资料。方法采用Cochrane系统评价的方法,检索上述文献,按照纳入和排除标准限定研究对象,通过Jadad评分量表进行文献质量评估后,使用Cochrane协作网提供的RevMan 5.1统计软件进行Meta分析,以获得二者治疗CRVO继发黄斑水肿的疗效及安全性是否有差异的相关证据。主要指标中央黄斑厚度(CMT),最佳矫正视力,不良反应。结果共纳入玻璃体腔注射贝伐单抗或曲安奈德对比治疗CRVO继发黄斑水肿的临床对照研究6项(共242眼)。Meta分析结果显示,首选IVB组与首选IVT组的患者CMT降低幅度的差异为-33.22μm(95%CI:-74.85μm^8.42μm)(P=0.12),提高BCVA幅度的差异为0.01(95%CI:-0.13~0.14)(P=0.92)。首选IVB发生不良反应的比例低于首选IVT(合并比值比为0.03,95%CI:0.01~0.10)。结论采用首选IVB与IVT对比治疗CRVO继发黄斑水肿时,在降低CMT及提高BCVA方面二者疗效相仿,但安全性方面IVT明显较IVB差。二者间谁更适合作为CRVO继发黄斑水肿的首选治疗,尚需更多前瞻性大样本的临床随机对照试验数据支持。

Objective To evaluate the efficacy and safety in treatment of maeular edema （ME） secondary to central retinal vein oc- clusion（CRVO） by intravitreal bevacizumab （IVB） with intravitreal triamcinolone acetonide （IVT） for first priority. Design Meta-analysis. Participants Published literature in Medline, EMbase, Coehrane library and CBM which comparing IVB with IVT in treatment of ME secondary to CRVO for first priority. Method According to evaluation guidelines of Cochrane collaboration, clinical controlled trials （CCTs） were searched using Medline, EMbase, the Cochrane Library and CBM. Methodology qualities of literatures were performed by experienced researchers according to the Jadad Score. RevMan 5.1 offered by Cochrane was used to do the meta-aualysis. Main Out- come Measures Central maeular thickness （CMT）, best corrected visual acuity （BCVA）, and adverse events. Results Only 6 literatures came into meta-analysis （242 eyes）. No significant difference in either CMT （P=0.12） or BCVA （P=0.92） was observed between IVB and IVT group. Adverse event rates （mainly elevation of intraocular pressure and progression of cataracts） in IVT group was 33 times （95%CI： 10 times-100 times） more than IVB group （P〈0.001）. Conclusion Meta-analysis shows that the equal reduced CMT and BCVA was ob- served in IVT group and in IVB group for treatment of ME secondary to CRVO, while the adverse event rate in IVT group is much more than in IVB group. More high quality perspective studies are still required for further analysis.