Download PDF
Klin Monbl Augenheilkd 2017; 234(04): 551-555
DOI: 10.1055/s-0042-123025
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

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

Ergebnisse einer Metaanalyse zur intravitrealen anti-VEGF-Behandlung von Makulaödemen nach Venenastverschlüssen
H. Gerding
1   Augenzentrum Pallas Kliniken, Olten/Switzerland (Director: Prof. Dr. med. Heinrich Gerding, F. E. B. O.)
2   Department of Ophthalmology, University of Münster (Chairman: Prof. Dr. med. Nicole Eter)
› Author Affiliations
Further Information

Publication History

Publication Date:
13 February 2017 (online)

Also available at
    Permissions and Reprints

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
 

  • References

  • 1 The Branch Vein Occlusion Study Group. Argon laser photocoagulation for macular edema in branch retinal vein occlusion. Am J Ophthalmol 1984; 98: 271-282
    CrossrefPubMedGoogle Scholar
  • 2 Campochiaro PA, Clark WL, Boyer DS. et al. Intravitreal aflibercept for macular edema following branch retinal vein occlusion: the 24-week results of the VIBRANT study. Ophthalmology 2015; 122: 538-544
    CrossrefPubMedGoogle Scholar
  • 3 Clark WL, Boyer DS, Heier JS. et al. Intravitreal aflibercept for macular edema following branch retinal vein occlusion: 52-week results of the VIBRANT study. Ophthalmology 2016; 123: 330-336
    CrossrefPubMedGoogle Scholar
  • 4 Tadayoni R, Waldstein SM, Boscia F. et al. Individualized stabilization criteria-driven Ranibizumab versus laser in branch retinal vein occlusion. Ophthalmology 2016; 123: 1333-1344
    PubMedGoogle Scholar
  • 5 Gerding H, Wildberger H. Anti-VEGF-Injektionstherapie bei retinalen Venenverschlüssen. Ophta 2016; 22: 165-167
    PubMedGoogle Scholar
  • 6 Shroff D, Metha DK, Arora R. et al. Natural history of macular status in recent-onset branch retinal vein occlusion: an optical coherence tomography study. Int Ophthalmol 2008; 28: 261-268
    CrossrefPubMedGoogle Scholar
  • 7 Campochiaro PA, Heier JS, Feiner L. et al. Ranibizumab for macular edema following branch retinal vein occlusion. Ophthalmology 2010; 117: 1102-1112
    CrossrefPubMedGoogle Scholar
  • 8 Brown DM, Campochiaro PA, Bhisitkul RB. et al. Sustained benefits from ranibizumab for macular edema following branch retinal vein occlusion: 12-month outcomes of a phase III study. Ophthalmology 2011; 118: 1594-1602
    CrossrefPubMedGoogle Scholar
  • 9 Gerding H. Long-term results of intravitreal anti-VEGF injections in wet AMD: A meta-analysis. Klin Monatsbl Augenheilkd 2016; 233: 471-474
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Adelman RA, Parnes AJ, Bopp S. et al. Strategy for the management of macular edema in retinal vein occlusion: The European VitreoRetinal Society macular edema study. Biomed Res Int 2015; 2015: 870987
    PubMedGoogle Scholar
  • 11 Ahn SJ, Ahn J, Woo SJ. et al. Initial dose of three monthly intravitreal injections versus PRN intravitreal injections of bevacizumab for macular edema secondary to branch retinal vein occlusion. Biomed Res Int 2013; 2013: 209735
    PubMedGoogle Scholar
  • 12 Brynskov T, Kemp H, Sørensen TL. Intravitreal ranibizumab for retinal vein occlusion through 1 year in clinical practice. Retina 2014; 34: 1637-1643
    CrossrefPubMedGoogle Scholar
  • 13 Byun YJ, Roh MI, Lee SC. et al. Intravitreal triamcinolone acetonide versus bevacizumab therapy for macular edema associated with branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2010; 248: 963-971
    CrossrefPubMedGoogle Scholar
  • 14 Campochiaro PA, Hafiz G, Channa R. et al. Antagonism of vascular endothelial growth factor for macular edema caused by retinal vein occlusions: two-year outcomes. Ophthalmology 2010; 117: 2387-2394
    CrossrefPubMedGoogle Scholar
  • 15 Campochiaro PA, Hafiz G, Mir TA. et al. Scatter photocoagulation does not reduce macular edema or treatment burden in patients with retinal vein occlusion: the RELATE trial. Ophthalmology 2015; 122: 1426-1437
    CrossrefPubMedGoogle Scholar
  • 16 Farinha C, Marques JP, Almeida E. et al. Treatment of retinal vein occlusion with ranibizumab in clinical practice: longer-term results and predictive factors of functional outcome. Ophthalmic Res 2015; 55: 10-18
    CrossrefPubMedGoogle Scholar
  • 17 Figueroa MS, Contreras I, Noval S. et al. Results of bevacizumab as the primary treatment for retinal vein occlusions. Br J Ophthalmol 2010; 94: 1052-1056
    CrossrefPubMedGoogle Scholar
  • 18 Gregori NZ, Rattan GH, Rosenfeld PJ. et al. Safety and efficacy of intravitreal bevacizumab (Avastin) for the management of branch and hemiretinal vein occlusion. Retina 2009; 29: 913-925
    CrossrefPubMedGoogle Scholar
  • 19 Higashiyama T, Sawada O, Kakinoki M. et al. Prospective comparisons of intravitreal injections of triamcinolone acetonide and bevacizumab for macular oedema due to branch retinal vein occlusion. Acta Ophthalmol 2013; 91: 318-324
    CrossrefPubMedGoogle Scholar
  • 20 Hikichi T, Higuchi M, Matsushita T. Two-year outcomes of intravitreal bevacizumab therapy for macular oedema secondary to branch retinal vein occlusion. Br J Ophthalmol 2014; 98: 195-199
    CrossrefPubMedGoogle Scholar
  • 21 Jaissle G, Leitritz M, Gelisken F. et al. One-year results after intravitreal bevacizumab therapy for macular edema secondary to branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2009; 247: 27-33
    CrossrefPubMedGoogle Scholar
  • 22 Jaissle GB, Szurman P, Feltgen N. et al. Predictive factors for functional improvement after intravitreal bevacizumab therapy for macular edema due to branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 2011; 249: 183-192
    CrossrefPubMedGoogle Scholar
  • 23 Kim M, Yu SY, Kim ES et al. Intravitreal ranibizumab for macular edema secondary to retinal vein occlusion. Ophthalmologica 2012; 227: 132-138
    CrossrefPubMedGoogle Scholar
  • 24 Kim M, Lee DH, Byeon SH. et al. Comparison of intravitreal bevacizumab and dexamethasone implant for the treatment of macula oedema associated with branch retinal vein occlusion. Br J Ophthalmol 2015; 99: 1271-1276
    CrossrefPubMedGoogle Scholar
  • 25 Kondo M, Kondo N, Ito Y. et al. Intravitreal injection of bevacizumab for macular edema secondary to branch retinal vein occlusion. Retina 2009; 29: 1242-1248
    CrossrefPubMedGoogle Scholar
  • 26 Kreutzer TC, Alge CS, Wolf AH. et al. Intravitreal bevacizumab for the treatment of macular oedema secondary to branch retinal vein occlusion. Br J Ophthalmol 2008; 92: 351-355
    CrossrefPubMedGoogle Scholar
  • 27 Kumagai K, Ogino N, Furukawa M et al. Three treatments for macular edema because of branch retinal vein occlusion. Retina 2012; 32: 520-529
    CrossrefPubMedGoogle Scholar
  • 28 Kwon SI, Kim YW, Bang YW. et al. Comparison of natural course, intravitreal triamcinolone, and intravitreal bevacizumab for treatment of macular edema secondary to branch retinal vein occlusion. J Ocul Pharmacol Ther 2013; 29: 5-9
    CrossrefPubMedGoogle Scholar
  • 29 Larsen M, Waldstein SM, Boscia F. et al. Individualized ranibizumab regimen driven by stabilization criteria for central retinal vein occlusion: Twelve-month results of the CRYSTAL study. Ophthalmology 2016; 123: 1101-1111
    CrossrefPubMedGoogle Scholar
  • 30 Mylonas G, Sacu S, Dunavoelgyi R. et al. Response of retinal sensitivity to ranibizumab treatment of macular edema after acute branch retinal vein occlusion. Retina 2013; 33: 1220-1226
    CrossrefPubMedGoogle Scholar
  • 31 Narayanan R, Panchal B, Das T. et al. A randomized, double-masked, controlled study of the efficacy and safety of intravitreal bevacizumab versus ranibizumab in the treatment of macular oedema due to branch retinal vein occlusion: MARVEL report No. 1. Br J Ophthalmol 2015; 99: 954-959
    CrossrefPubMedGoogle Scholar
  • 32 Rensch F, Jonas JB, Spandau UHM. Early intravitreal bevacizumab for non-ischemic branch retinal vein occlusion. Ophthalmologica 2009; 223: 124-127
    CrossrefPubMedGoogle Scholar
  • 33 Rush RB, Sumunovic MP, Aragon AV. et al. Treat-and-extend intravitreal bevacizumab for branch retinal vein occlusion. Ophthalmic Surg Lasers Imaging Retina 2014; 45: 212-216
    CrossrefPubMedGoogle Scholar
  • 34 Russo V, Barone A, Conte E. et al. Bevacizumab compared with macular laser grid photocoagulation for cystoid macular edema in branch retinal vein occlusion. Retina 2009; 29: 511-515
    CrossrefPubMedGoogle Scholar
  • 35 Sato T, Sawada K, Iwahashi-Shima C. et al. 25-gauge vitrectomy versus intravitreal bevacizumab for macular edema secondary to branch retinal vein occlusion: 1 year follow-up. Ann Acad Med Singapore 2012; 41: 294-299
    PubMedGoogle Scholar
  • 36 Axer-Siegel R, Dreznik A, Mimouni K. et al. Intravitreal bevacizumab treatment of macular edema due to branch retinal vein occlusion in a clinical setting. Curr Eye Res 2012; 37: 823-829
    CrossrefPubMedGoogle Scholar
  • 37 Tan MH, McAllister IL, Gillies ME. et al. Randomized controlled trial of intravitreal ranibizumab versus standard grid laser for macular edema following branch retinal vein occlusion. Am J Ophthalmol 2014; 157: 237-247
    CrossrefPubMedGoogle Scholar
  • 38 Wu L, Arevalo JF, Berrocal MH. et al. Comparison of two doses of intravitreal bevacizumab as primary treatment for macular edema secondary to branch retinal vein occlusion. Retina 2009; 29: 1396-1403
    CrossrefPubMedGoogle Scholar
  • 39 Gerding H. Intravitreal anti-VEGF treatment in central retinal vein occlusion (CRVO): A meta-analysis of one-year results. Klin Monatsbl Augenheilkd 2017; 234: 546-550
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Gerding H. Ranibizumab treatment in age-related macular degeneration: A meta-analysis of one-year results. Klin Monatsbl Augenheilkd 2014; 231: 427-431
    Article in Thieme ConnectPubMedGoogle Scholar
  • 41 Schmidt-Erfurth U, Lang GE, Holz FG. et al. Three-year outcomes of individualized ranibizumab treatment in patients with diabetic macular edema: the RESTORE extension study. Ophthalmology 2014; 121: 1045-1053
    CrossrefPubMedGoogle Scholar
  • 42 Gerding H, Loukopoulos V, Riese J. et al. Results of flexible ranibizumab treatment in age-related macular degeneration and search for parameters with impact on outcome. Graefes Arch Clin Exp Ophthalmol 2011; 249: 653-662
    CrossrefPubMedGoogle Scholar
  • 43 Gerding H, Monés J, Tadayoni R. et al. Ranibizumab in retinal vein occlusion: treatment recommendations by an expert panel. Br J Ophthalmol 2015; 99: 297-300
    CrossrefPubMedGoogle Scholar