Interventions for central retinal vein occlusion - An evidence-based systematic review
Interventions for central retinal vein occlusion - An evidence-based systematic review
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DOI：
10.1016/j.ophtha.2006.11.011
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发表时间：
2007-03-01
期刊：
影响因子：
13.7
通讯作者：
Wong, Tien Yin
中科院分区：
文献类型：
--
作者：
Mohamed, Quresh;McIntosh, Rachel L.;Wong, Tien Yin
题目：评估干预措施有效性的证据，以提高视力（VA）和预防或治疗继发于视网膜中央静脉阻塞（CRVO）的新生血管。临床相关性：视网膜中央静脉阻塞是视力发病和失明的常见原因。许多不同的干预措施已被提倡，但证明其使用的证据仍不清楚。方法/文献综述。使用关键词检索Medline（1966年以后）、Embase、科克伦协作网、美国国立卫生研究院临床试验数据库和视觉与眼科学研究协会（2003-2005年）检索英语和非英语文章。通过手动检索综述文章的参考文献进行补充。两名研究人员独立确定所有随机临床试验（RCT）的干预措施，在CRVO超过3个月的follow.Results：检索到的4133引文，17个RCT比较干预与对照组被确定。有4篇关于激光光凝的RCT。格栅状黄斑激光光凝不能改善伴有黄斑水肿的CRVO患者的视力。预防性全视网膜光凝不能预防缺血性CRVO中的房角和虹膜新生血管形成，但可导致房角和虹膜新生血管形成消退，并减少新生血管性青光眼的进展。有4项RCT报告了住院患者血液稀释后VA改善，2项RCT无显著改善，1项RCT显示门诊患者血液稀释后VA恶化。随机临床试验评估替卡松，曲塞鲁肽，和链激酶显示有限或没有benefit.Conclusions：本次审查发现有限的I级证据的任何干预措施，以改善视力CRVO患者。全视网膜光凝导致新生血管消退。血液稀释可以改善某些患者的视力，但数据相互矛盾。需要更可靠的随机对照试验来评估CRVO的当前治疗方法。正在进行的关于玻璃体内注射曲安奈德、抗血管内皮生长因子药物和脉络膜视网膜吻合术的随机对照试验的结果值得关注。
Topic: To assess the evidence for the effectiveness of interventions to improve visual acuity (VA) and prevent or treat neovascularization secondary to central retinal vein occlusion (CRVO).Clinical Relevance: Central retinal vein occlusion is a common cause of visual morbidity and blindness. Many different interventions have been advocated, but the evidence justifying their use remains unclear.Methods/Literature Reviewed. English and non-English language articles were retrieved using a keyword search of Medline (1966 onwards), Embase, the Cochrane Collaboration, the National Institutes of Health Clinical Trials database, and the Association for Research in Vision and Ophthalmology (2003-2005). This was supplemented by manually searching references of review articles. Two investigators independently identified all randomized clinical trials (RCTs) on interventions in CRVO with more than 3 months' follow-up.Results: Of 4133 citations retrieved, 17 RCTs comparing intervention with a control group were identified. There were 4 RCTs on laser photocoagulation. Grid macular laser photocoagulation did not improve VA in CRVO with macular edema. Prophylactic panretinal photocoagulation did not prevent angle and iris neovascularization in ischemic CRVO, but resulted in regression of angle and iris neovascularization and reduced progression to neovascular glaucoma. There were 4 RCTs that reported improvement in VA with inpatient hemodilution, 2 RCTs with no significant improvement, and 1 RCT showing deterioration in VA after outpatient hemodilution. Randomized clinical trials evaluating ticlodipine, troxerutin, and streptokinase showed a limited or no benefit.Conclusions: This review found limited level I evidence for any intervention to improve VA in patients with CRVO. Panretinal photocoagulation resulted in regression of neovascularization. Hemodilution may improve vision in some patients, but the data conflict. More robust randomized controlled trials evaluating current treatments for CRVO are needed. The results of ongoing RCTs on intravitreal triamcinolone, anti-vascular endothelial growth factor agents, and chorioretinal anastomosis are awaited with interest.