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Lashay A, Riazi-Esfahani H, Mirghorbani M, Yaseri M. Intravitreal Medications for Retinal Vein Occlusion: Systematic Review and Meta-analysis. JOVR [Internet]. 2019Jul.18 [cited 2024Apr.23];14(3):336–365. Available from: https://knepublishing.com/index.php/JOVR/article/view/4791
https://doi.org/10.18502/jovr.v14i3.4791
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- Cited by 5 articles
authors
-
Alireza Lashay
Alireza Lashay
Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
-
Hamid Riazi-Esfahani
Hamid Riazi-Esfahani
Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
-
Masoud Mirghorbani
Masoud Mirghorbani
Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
-
Mehdi Yaseri
Mehdi Yaseri
Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
Published Date
- Jul 18, 2019
Intravitreal Medications for Retinal Vein Occlusion: Systematic Review and Meta-analysis
Abstract
Purpose: To evaluate the outcomes of different intravitreal injections for the treatment of retinal vein occlusion including central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO).
Methods: PubMed, Cochrane, the metaRegister of ControlledTrials, and ClinicalTrials were searched for intravitreal anti-Vascular Endothelial Growth Factor (VEGF) and steroids with relevant keywords and date limitation of 2009-2018. Meta-analysis was performed on studies that met the defined inclusion criteria. Main outcomes were visual acuity (VA) and central macular thickness (CMT).
Results: Out of 681 studies, 36 articles (including 21 reporting CRVO and 15 dealing with BRVO) were selected for systematic review. All five intravitreal drugs including triamcinolone, dexamethasone, ranibizumab, bevacizumab, and aflibercept showed improvement of CMT and VA as compared to placebo or laser treatment. Six randomized controlled trials were selected for meta-analysis in RVO patients. The pooled mean difference of visual improvement between sham and ranibizumab was 12.7 Early Treatment for Diabetic Retinopathy Study (ETDRS) letters (95%CI: 11.00 to 13.2), and the pooled mean difference in CMT reduction was 221 μm (95%CI: 153 to 284); both changes were significantly in favor of ranibizumab. The pooled mean difference of visual improvement between bevacizumab and triamcinolone was 5.3 ETDRS letters in favor of bevacizumab (95%CI: 16 μm to 17.5 μm). Triamcinolone led to 68.1 μm greater CMT reduction than bevacizumab (95%CI: 58 μm to 76 μm). However, none of these differences were statistically significant.
Conclusion: Treatment with anti-VEGF agents in RVO is superior to observation. No significant difference was seen between the eyes treated with bevacizumab or triamcinolone based on these results.
Keywords:
Anti-vascular Endothelial Growth Factor; Dexamethasone; Retinal Vein Occlusion; Triamcinolone
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2. Bertelsen M, Linneberg A, Christoffersen N, Vorum H, Gade E, Larsen M. Mortality in patients with central retinal vein occlusion. Ophthalmology 2014;121:637-642.
3. Elman MJ, Bhatt AK, Quinlan PM, Enger C. The risk for systemic vascular diseases and mortality in patients with central retinal vein occlusion. Ophthalmology 1990;97:1543-1548.
4. Dodson PM, Galton DJ, Hamilton AM, Blach RK. Retinal vein occlusion and the prevalence of lipoprotein abnormalities. Br J Ophthalmol 1982;66:161-164.
5. Koizumi H, Ferrara DC, Brue C, Spaide RF. Central retinal vein occlusion case-control study. Am J Ophthalmol
2007;144:858-863.
6. Wang YX, Zhang JS, You QS, Xu L, Jonas JB. Ocular diseases and 10-year mortality: the Beijing Eye Study
2001/2011. Acta Ophthalmol 2014;92:e424-e428.
7. Hayreh SS. Ocular vascular occlusive disorders: natural history of visual outcome. Prog Retin Eye Res 2014;41:1-25.
8. Glacet-Bernard A, Coscas G, Chabanel A, Zourdani A, Lelong F, Samama MM. Prognostic factors for retinal vein
occlusion: prospective study of 175 cases. Ophthalmology 1996;103:551-560.
9. Argon laser photocoagulation for macular edema in branch vein occlusion. The branch vein occlusion study
group. Am J Ophthalmol 1984;98:271-282.
10. Varma R, Bressler NM, Suner I, Lee P, Dolan CM, Ward J, et al. Improved vision-related function after ranibizumab for macular edema after retinal vein occlusion: results from the BRAVO and CRUISE trials. Ophthalmology 2012;119:2108-2118.
11. Hayreh SS, Podhajsky PA, Zimmerman MB. Branch retinal artery occlusion: natural history of visual outcome. Ophthalmology 2009;116:1188-1194.e1-e4.
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http://www.cebm.net/index. aspx?o.1025.
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14. Moher D, Liberati A, Tetzlaff J, Altman DG, The PG. Preferred reporting items for systematic reviews and
meta-analyses: the PRISMA statement. PLOS Med 2009;6:e1000097.
15. Ip MS, Gottlieb JL, Kahana A, Scott IU, Altaweel MM, Blodi BA, et al. Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion. Arch Ophthalmol (Chicago, Ill : 1960) 2004;122:1131-1136.
16. Braithwaite T, Nanji AA, Lindsley K, Greenberg PB. Antivascular endothelial growth factor for macular oedema
secondary to central retinal vein occlusion. Cochrane Database Syst Rev 2014:Cd007325.
17. Mohamed Q, McIntosh RL, Saw SM, Wong TY. Interventions for central retinal vein occlusion: an evidence-based systematic review. Ophthalmology 2007;114:507-519, 524.
18. Ip MS, Scott IU, VanVeldhuisen PC, Oden NL, Blodi BA, Fisher M, et al. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with observation to treat vision loss associated with macular edema secondary to central retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report
5. Arch Ophthalmol (Chicago, Ill : 1960) 2009;127:1101-1114. 19. Jonas JB, Degenring RF, Kamppeter BA, Kreissig I,
Akkoyun I. Duration of the effect of intravitreal triamcinolone acetonide as treatment for diffuse diabetic macular
edema. Am J Ophthalmol 2004;138:158-160.
20. Jonas JB, Jonas RA, Neumaier M, Findeisen P. Cytokine concentration in aqueous humor of eyes with diabetic
macular edema. Retina 2012;32:2150-2157.
21. Ramezani A, Esfandiari H, Entezari M, Moradian S, Soheilian M, Dehsarvi B, et al. Three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent onset central retinal vein occlusion. Acta Ophthalmol 2014;92:e530-e539.
22. Ding X, Li J, Hu X, Yu S, Pan J, Tang S. Prospective study of intravitreal triamcinolone acetonide versus bevacizumab for macular edema secondary to central retinal vein occlusion. Retina 2011;31:838-845.
23. Haller JA, Bandello F, Belfort R, Jr., Blumenkranz MS, Gillies M, Heier J, et al. Randomized, sham-controlled
trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology 2010;117:1134-1146.e3.
24. Haller JA, Bandello F, Belfort R, Jr., Blumenkranz MS, Gillies M, Heier J, et al. Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results. Ophthalmology 2011;118:2453-2460.
25. Bezatis A, Spital G, Hohn F, Maier M, Clemens CR, Wachtlin J, et al. Functional and anatomical results after
a single intravitreal Ozurdex injection in retinal vein occlusion: a 6-month follow-up – the SOLO study. Acta
Ophthalmol 2013;91:e340-e347.
26. Hoerauf H, Feltgen N, Weiss C, Paulus EM, SchmitzValckenberg S, Pielen A, et al. Clinical efficacy and safety
of ranibizumab versus dexamethasone for central retinal vein occlusion (COMRADE C): a European label study. Am J Ophthalmol 2016;169:258-267.
27. Gado AS, Macky TA. Dexamethasone intravitreous implant versus bevacizumab for central retinal vein occlusionrelated macular oedema: a prospective randomized comparison. Clin Exp Ophthalmol 2014;42:650-655.
28. Kinge B, Stordahl PB, Forsaa V, Fossen K, Haugstad M, Helgesen OH, et al. Efficacy of ranibizumab in patients
with macular edema secondary to central retinal vein occlusion: results from the sham-controlled ROCC study.
Am J Ophthalmol 2010;150:310-314.
29. Brown DM, Campochiaro PA, Singh RP, Li Z, Gray S, Saroj N, et al. Ranibizumab for macular edema following central retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology 2010;117:1124-1133.e1.
30. Campochiaro PA, Brown DM, Awh CC, Lee SY, Gray S, Saroj N, et al. Sustained benefits from ranibizumab for
macular edema following central retinal vein occlusion: twelve-month outcomes of a phase III study. Ophthalmology 2011;118:2041-2049.
31. Heier JS, Campochiaro PA, Yau L, Li Z, Saroj N, Rubio RG, et al. Ranibizumab for macular edema due to retinal
vein occlusions: long-term follow-up in the HORIZON trial. ophthalmology 2012;119:802-809.
32. Thach AB, Yau L, Hoang C, Tuomi L. Time to clinically significant visual acuity gains after ranibizumab treatment for retinal vein occlusion: BRAVO and CRUISE trials. Ophthalmology 2014;121:1059-1066.
33. Kriechbaum K, Michels S, Prager F, Georgopoulos M, Funk M, Geitzenauer W, et al. Intravitreal Avastin for macular oedema secondary to retinal vein occlusion: a prospective study. Br J Ophthalmol 2008;92:518.
34. Prager F, Michels S, Kriechbaum K, Georgopoulos M, Funk M, Geitzenauer W, et al. Intravitreal bevacizumab
(Avastin) for macular oedema secondary to retinal vein occlusion: 12-month results of a prospective clinical trial.
Br J Ophthalmol 2009;93:452-456.
35. Zhang H, Liu Z-L, Sun P, Gu F. Intravitreal bevacizumab fortreatment of macular edema secondary to central retinal vein occlusion: eighteen-month results of a prospective trial. J Ocul Pharmacol Ther 2011;27:615-621.
36. Epstein DL, Algvere PV, von Wendt G, Seregard S, Kvanta A. Bevacizumab for macular edema in central retinal veinocclusion: a prospective, randomized, double-masked clinical study. Ophthalmology 2012;119:1184-1189.
37. Epstein DL, Algvere PV, von Wendt G, Seregard S, Kvanta A. Benefit from bevacizumab for macular edema in central retinal vein occlusion: twelve-month results of a prospective, randomized study. Ophthalmology 2012;119:2587- 2591.
38. Rajagopal R, Shah GK, Blinder KJ, Altaweel M, Eliott D, Wee R, et al. Bevacizumab versus ranibizumab in the
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