Therapies for Macular Edema Associated with Central Retinal Vein Occlusion A Report by the American Academy of Ophthalmology
Therapies for Macular Edema Associated with Central Retinal Vein Occlusion A Report by the American Academy of Ophthalmology
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DOI：
10.1016/j.ophtha.2014.10.013
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发表时间：
2015-04-01
期刊：
影响因子：
13.7
通讯作者：
Thorne, Jennifer E.
中科院分区：
文献类型：
--
作者：
Yeh, Steven;Kim, Stephen J.;Thorne, Jennifer E.
目的：回顾有关视网膜中央静脉阻塞(CRVO)相关性黄斑水肿(ME)治疗方法的安全性和有效性的现有证据。方法：最后一次检索PubMed数据库是在2014年3月，没有日期限制，但限定文章语言种类为英文。2014年3月，Cochrane图书馆也进行了文献搜索，没有日期限制，也没有语言限制。合并搜索产生了108条引文，其中20条被认为与临床相关，供眼科技术评估委员会视网膜/玻璃体小组全文审查。另外三项研究也被确定为小组审查。结果：有4项临床试验的7篇引文提供了I级证据，支持使用抗血管内皮生长因子(VEGF)药物疗法治疗与CRVO相关的ME，包括玻璃体内注射雷尼比珠单抗(2)、阿普利赛特(3)和贝伐单抗(2)。有3篇引文代表了2项具有I级证据的研究，即地塞米松玻璃体内植入皮质类固醇注射(2篇引文)或曲安奈德(1篇引文)，尽管这些研究中观察到了白内障和青光眼。I级证据表明黄斑网格型激光光凝的益处有限(引文1)。另外8篇文献被评为II级，4篇文献被评为III级。目前，长期疗效结果(随访2年)仅限于玻璃体内雷尼比珠单抗，很少有研究评估联合应用抗血管内皮生长因子和皮质类固醇两种药物的疗效。结论：I级证据表明，玻璃体内抗血管内皮生长因子药物治疗与CRVO相关的ME2年以上是安全有效的，延迟治疗与较差的视力结果相关。此外，I级证据显示玻璃体内注射糖皮质激素有短期疗效，但也与较高的不良事件发生率有关。(C)2015年，由美国眼科学会颁发。
Purpose: To review the available evidence regarding the safety and efficacy of therapies for the treatment of macular edema (ME) associated with central retinal vein occlusion (CRVO).Methods: A literature search of the PubMed database was last conducted in March 2014 with no date restrictions but limited to articles published in English. A literature search of the Cochrane Librarywas also conducted in March 2014with no date restrictions andwithout a language limitation. The combined searches yielded 108 citations, of which 20 were deemed clinically relevant for the Ophthalmic Technology Assessment Committee Retina/Vitreous panel to review in full text. Three additional studies were also identified for panel review. The level of evidence of these selected studies was reviewed by the panel methodologist.Results: There were 7 citations representing 4 clinical trials that provided level I evidence supporting the use of anti-vascular endothelial growth factor (VEGF) pharmacotherapies for ME associated with CRVO, including intravitreal ranibizumab (2), aflibercept (3), and bevacizumab (2). There were 3 citations representing 2 studies with level I evidence for intravitreal corticosteroid injection with dexamethasone intravitreal implant (2 citations) or triamcinolone (1 citation), although cataract and glaucoma were observed in these studies. Level I evidence is available on the limited benefit of macular grid-pattern laser photocoagulation (1 citation). Eight other citations reviewed were rated as level II, and 4 citations were rated as level III. Long-term efficacy results (>= 2 years of follow-up) are limited to intravitreal ranibizumab at this time, and few studies have evaluated combination therapy with anti-VEGF and corticosteroid versus monotherapy of either class of drug.Conclusions: Level I evidence indicates that intravitreal anti-VEGF pharmacotherapy is safe and effective over 2 years for MEassociated with CRVO and that delay in treatment is associatedwithworse visual outcomes. In addition, level I evidence demonstrates short-term efficacy of intravitreal corticosteroid but also an association with a higher frequency of adverse events. (C) 2015 by theAmericanAcademy ofOphthalmology.