不同抗VEGF药物治疗视网膜静脉阻塞继发黄斑水肿疗效的系统评价

Efficacy of different anti-VEGF drugs in the treatment of macular edema secondary to retinal vein occlusion:a systematic review

目的评估玻璃体腔内注射抗血管内皮生长因子(anti-vascular endothelial growth factors,antiVEGF)对视网膜静脉阻塞(retinal vein occlusion,RVO)继发黄斑水肿(macular edema,ME)的疗效。方法计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、CNKI、WanFang Data和VIP数据库,搜集关于玻璃体腔内注射贝伐单抗、雷珠单抗和阿柏西普治疗RVO-ME的随机对照试验(RCT),检索时限均从建库至2021年9月17日。由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入11个RCT,包括2436只眼,其中,视网膜中央静脉阻塞1682只眼,视网膜分支静脉阻塞754只眼。Meta分析结果显示:(1)随访第6个月时,抗VEGF药物治疗RVO-ME在最佳矫正视力改善[MD=14.97,95%CI(10.09,19.86),P<0.00001]和视网膜中央厚度的减少[MD=-218.21,95%CI(-295.56,-140.86),P<0.00001]方面均优于安慰剂组;在第12个月时,抗VEGF药物治疗RVO-ME在最佳矫正视力的改善[MD=5.70,95%CI(3.90,7.50),P<0.00001]方面优于安慰剂组;(2)不同抗VEGF药物在改善最佳矫正视力上,差异无统计学意义。但不同抗VEGF药物在视网膜中央静脉阻塞患者的视网膜中央厚度改善上:阿柏西普和贝伐单抗[MD=-46.79,95%CI(-83.12,-10.46),P=0.01],贝伐单抗和雷珠单抗[MD=76.03,95%CI(30.76,121.30),P=0.001],两组差异均有统计学意义。结论现有证据表明,抗VEGF药物在RVO-ME的治疗中可提高视力,减少黄斑水肿。贝伐单抗可能是雷珠单抗或阿柏西普的有效替代品,现有证据尚无法确定它们在长期治疗RVO期间最佳矫正视力改善和视网膜中央厚度减少是否存在差异,有待进一步研究验证。

Objective To systematically review the efficacy of intravitreal injection of anti-vascular endothelial growth factors(anti-VEGF)on macular edema(ME)secondary to retinal vein occlusion(RVO).Methods Databases including PubMed,EMbase,Web of Science,The Cochrane Library,CNKI,WanFang Data and VIP were electronically searched to identify randomized controlled trials on different anti-VEGF drugs in the treatment of RVO-ME from inception to September 17^(th) 2021.Two reviewers independently screened literature,extracted data,and assessed the risk bias of the included studies.Meta-analysis was then performed using RevMan 5.3 software.Results A total of 11 RCTs were included.Data from these studies included 2436 eyes,of which 1682 involved central retinal vein occlusion and 754 involved branch retinal vein occlusion.The results of meta-analysis showed that at 6 months of follow-up,anti-VEGF drug treatment of RVO-ME improved corrected visual acuity(MD=14.97,95%CI 10.09 to 19.86,P<0.00001)and reduced central retinal thickness(MD=-218.21,95%CI-295.56 to-140.86,P<0.00001)compared with control groups.At 12 months,anti-VEGF treatment of RVO-ME showed better improvement in corrected visual acuity compared with control group(MD=5.70,95%CI 3.90 to 7.50,P<0.00001).No statistically differences were observed in the improvements corrected visual acuity with different anti-VEGF drugs.However,for central retinal vein occlusion,different anti-VEGF drugs improved the central retinal thickness including aflibercept vs.bevacizumab(MD=-46.79,95%CI-83.12 to-10.46,P=0.01),and bevacizumab vs.ranibizumab(MD=76.03,95%CI 30.76 to 121.30,P=0.001)had significant differences.Conclusions The current evidence shows that anti-VEGF drugs can improve vision and reduce macular edema in the treatment of RVO-ME.Bevacizumab may be an effective alternative to ranibizumab or aflibercept.Existing evidence cannot determine differences between the improvement of best-corrected vision and the reduction of central retinal thickness during the long-term treatment of RVO,which requires to be verified by further research.