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Klin Monbl Augenheilkd 2017; 234(04): 546-550
DOI: 10.1055/s-0042-123057
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Intravitreal anti-VEGF Treatment in Central Retinal Vein Occlusion (CRVO): a Meta-Analysis of One Year Results

Intravitreale anti-VEGF-Injektionstherapie bei Zentralvenenverschlüssen: eine Metaanalyse von Ergebnissen nach einem Behandlungsjahr
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)
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Publication History

Publication Date:
06 March 2017 (online)

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Abstract

Background It was the aim of this meta-analysis to assess the 12-month efficacy of intravitreal anti-vascular endothelial growth factor therapy in eyes with central retinal vein occlusion.

Patients and Methods A MEDLINE-based survey was performed, including 33 publications (27 case series), covering a total of 1834 treated eyes. Baseline data (age, length of symptoms, visual acuity, gain in visual acuity at 3, 6, and 12 months) and average numbers of injections were calculated. Linear and non-linear regressions were calculated to relate baseline and treatment parameters and outcome. In a subgroup analysis, outcome data of randomised and non-randomised studies were compared.

Results Mean gain in visual acuity was 2.8 ± 0.8 (mean±1 standard deviation), 2.7 ± 1.1 and 2.2 ± 1.4 lines at months 3, 6, and 12. 4.2 ± 1.2 and 6.4 ± 2.4 injections were given until months 6 and 12. Visual acuity gain improved significantly more in randomised trials (3.3 ± 0.7 and 3.0 ± 0.4, at months 6 and 12 versus 2.4 ± 1.1 and 2.2 ± 1.4, both p = 0.04) than in non-randomised studies. Eyes in randomised trials received significantly more injections (4.8 ± 1.1 and 8.6 ± 0.7 until month 6 and 12 versus 3.7 ± 1.0 and 5.6 ± 2.3, p = 0.045 and 0.04). After 12 months of care, the improvement in visual acuity was significantly correlating to the number of injections given. The dose response curve suggests saturation with treatment at an average of 7–8 injections within 12 months. The midpoint of the dose response curve was calculated at 6.78 injections per year.

Conclusions The results of this analysis show that an improvement of approximately 3 lines can be maintained in the first year. Careful observation seems necessary to avoid under-treatment, which may occur below an average of 7–8 injections within the first 12 months of treatment.

Zusammenfassung

Hintergrund Es war Ziel dieser Metaanalyse die Effektivität der anti-vascular-endothelial-growth-factor-Injektionstherapie bei Zentralvenenverschlüssen in den ersten 12 Monaten zu untersuchen.

Patienten und Methoden Die MEDLINE-basierte Analyse umfasste 33 Publikationen (27 Fallserien) mit insgesamt 1834 behandelten Augen. Basisdaten (Alter, Zeitdauer der Symptome, Visus, Visusgewinn (nach 3, 6, 12 Monaten) und die mittlere Injektionszahl wurden berechnet. Lineare und nicht lineare Regressionen wurden für die Relation zwischen Basis- und Behandlungsparametern und dem Visusgewinn analysiert. In einer Subgruppenanalyse wurden Ergebnisse randomisierter und nicht randomisierter Studien verglichen.

Ergebnisse Der mittlere Visusgewinn betrug 2.8 ± 0.8 (Mittelwert ± 1 Standardabweichung), 2.7 ± 1.1 und 2.2 ± 1.4 Linien nach 3, 6 und 12 Monaten. Im Mittel wurden 4.2 ± 1.2 und 6.4 ± 2.4 Injektionen innerhalb von 6 und 12 Monaten verabreicht. Der Visusgewinn in randomisierten Studien war signifikant größer (3.3 ± 0.7 (6 Monate), 3.0 ± 0.4 (12 Monate) als in nicht randomisierten Erhebungen (2.4 ± 1.1, 2.2 ± 1.4, beide p = 0.04). Augen in randomisierten Studien erhielten eine signifikant höhere Zahl an Injektionen (4.8 ± 1.1 bis Monat 6, 8.6 ± 0.7 bis Monat 12 versus 3.7 ± 1.0 und 5.6 ± 2.3, p = 0.045 und 0.04). Die Visusverbesserung nach 12 Monaten korrelierte signifikant mit der Injektionszahl. Die Dosis-Wirkungskurve deutet auf einen Sättigungseffekt ab 7–8 Injektionen innerhalb von 12 Monaten hin. Der Wendepunkt der Dosis-Wirkungskurve lag bei kalkulierten 6.78 Injektionen.

Schlussfolgerungen Die Ergebnisse dieser Analyse zeigen, dass eine Verbesserung von etwa 3 Linien im ersten Behandlungsjahr erreicht werden kann. Eine sorgfältige Observation erscheint notwendig, um eine Unterbehandlung zu vermeiden, die bei im Mittel unter 7–8 Injektionen in den ersten 12 Monaten auftreten kann.

Key words

central retinal vein occlusion - CRVO - anti-VEGF - ranibizumab - aflibercept - bevacizumab - vascular endothelial growth factor - meta-analysis - review

Schlüsselwörter

Zentralvenenverschluss - ZVV - anti-VEGF - Ranibizumab - Aflibercept - Bevacizumab - Vascular endothelial Growth Factor - Metaanalyse - Review
 

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