Results of a Meta-Analysis on Intravitreal anti-VEGF Treatment of Macular Oedema Secondary to Branch Retinal Vein Occlusion (BRVO)

Abstract

Background In this meta-analysis, the outcome was analysed of intravitreal anti-VEGF (vascular endothelial growth factor) ocular therapy of macular oedema secondary to branch retinal vein occlusion; this was related to baseline and treatment parameters.

Material and Methods 36 relevant publications (33 case series) were identified in a MEDLINE-based literature search, which reported on 1,759 treated eyes. Statistical analysis included description of baseline, treatment, and outcome data, linear and non-linear regression and comparison of randomised and non-randomised studies.

Results The mean improvement in visual acuity (VA) was 2.8 ± 0.9 lines (mean ± 1 standard deviation) at month 3, 3.1 ± 0.8 at month 6, and 3.2 ± 0.8 lines at month 12. The mean number of anti-VEGF injections was 3.8 ± 1.3 until month 6, and 4.1 ± 2.3 until month 12. Eyes in randomised trials received significantly more injections (4.8+/1.2) than those in non-randomised studies (2.9 ± 0.6, p = 0.0126) until month 6. At months 6 and 12, the gain in visual acuity was not significantly different between randomised and non-randomised studies (3.2 ± 0.4 versus 3.1 ± 1.0 lines, and 3.3 ± 0.4 versus 3.2 ± 1.0, respectively). Regression analysis did not indicate a significant relationship between the number of injections and the improvement in visual acuity at months 6 and 12. Visual acuity outcome was significantly worse in older patients at months 3, 6, and 12.

Conclusions The results of this meta-analysis demonstrate that a substantially improved and favourable absolute visual acuity can be achieved with relatively few anti-VEGF injections in eyes with branch retinal vein occlusion.

Zusammenfassung

Hintergrund In dieser Metaanalyse wurden Ergebnisse der intravitrealen anti-VEGF-Injektionstherapie in Augen mit Makulaödem nach Venenastverschlüssen untersucht und deren Relation zu Ausgangs- und Behandlungsdaten analysiert.

Material und Methoden 36 relevante Publikationen (33 Fallserien) mit insgesamt 1759 behandelten Augen konnten in einer MEDLINE-basierten Literatursuche identifiziert werden. Statistische Analysen beinhalteten eine Deskription der Basis-, Behandlungs- und Verlaufsdaten, lineare und nicht-lineare Regressionen und einen Vergleich zwischen randomisierten und nicht randomisierten Studien.

Ergebnisse Der mittlere Visusanstieg betrug 2.8 ± 0.9 Linien (Mittelwert ± 1 Standardabweichung) nach 3, 3.1 ± 0.8 nach 6 und 3.2 ± 0.8 Linien nach 12 Monaten. Innerhalb der ersten 6 Monate wurden 3.8 ± 1.3 Injektionen und bis zum Monat 12 4.1 ± 2.3 Injektionen verabreicht. In randomisierten Studien wurden signifikant mehr Injektionen bis zum Monat 6 als in nicht randomisierten Studien gegeben (4.8 ± 1.2 versus 2.9 ± 0.6, p = 0.0126). Zwischen randomisierten und nicht randomisierten Studien war kein signifikant unterschiedlicher Visusanstieg festzustellen (3.2 ± 0.4 versus 3.1 ± 1.0 nach 6 Monaten, 3.3 ± 0.4 versus 3.2 ± 1.0 nach 12 Monaten). In der Regressionsanalyse wurde keine signifikante Relation zwischen Injektionszahl und Visusanstieg nach 6 und 12 Monaten gefunden. Ältere Patienten zeigten nach 3, 6 und 12 Monaten einen signifikant geringeren Visusanstieg.

Schlussfolgerungen Die Ergebnisse dieser Metaanalyse unterstreichen, dass eine substanzielle Verbesserung und relativ gute Sehschärfe durch eine Anti-VEGF-Injektionstherapie bei relativ geringer Injektionszahl in Augen mit Makulaödem nach Venenastverschlüssen erzielt werden kann.

Key words

Branch retinal vein occlusion - BRVO - anti-VEGF - vascular endothelial growth factor - macular edema - ME - ranibizumab - aflibercept - bevacizumab - meta-analysis - review

Schlüsselwörter

Venenastverschluss - VAV - anti-VEGF - vascular endothelial growth factor - Makulaödem - MÖ - Ranibizumab - Aflibercept - Bevacizumab - Metaanalyse - Review

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