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Archives of Medical Research May 2017Age-related macular degeneration (AMD) is the worldwide leading cause of blindness among the elderly, especially in developed countries. The possible association between... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Age-related macular degeneration (AMD) is the worldwide leading cause of blindness among the elderly, especially in developed countries. The possible association between apolipoprotein E (ApoE) polymorphism (ε2, ε3, ε4) and AMD has been extensively investigated with conflicting results, especially when specifying different clinical phenotypes of AMD. Herein, we conducted a meta-analysis by integrating several recent large-sample studies to verify the effect of ApoE polymorphisms on AMD subtypes.
METHODS
The retrieve for targeted literature was conducted based on the PubMed, Embase, Cochrane library, and Web of Science. Summary odds ratio (OR) and its 95% confidence intervals (CIs) were used for estimation of risk. The p-value was adjusted due to the multiple comparison.
RESULTS
A total of 12 studies included in the final summary analysis, including 13842 cases and 38647 controls. ApoE ε4 carrier was inversely associated with early stage AMD (OR = 0.889, 95% CI = 0.82-0.97), geographic atrophy (OR = 0.594, 95% CI = 0.43-0.83) and neovascular AMD (OR = 0.670, 95% CI = 0.58-0.76). Stratification analysis by ethnicity revealed that the ApoE ε4 carriers was associated with neovascular AMD in both Caucasians (OR = 0.62, 95% CI = 0.47-0.83) and East Asians (OR = 0.68, 95% CI = 0.58-0.79). A significant association of ApoE ε2 carriers was only found with early AMD in Black and East Asian population, however small samples and limited studies restrict its generalization.
CONCLUSION
Our meta-analysis revealed a significantly protective role of ε4 on each subtypes of AMD, but no supportive evidence of the association of ε2 with AMD. Thus, further studies with larger samples are needed to understand the precise role of ε2 on AMD susceptibility.
Topics: Apolipoprotein E2; Apolipoprotein E3; Apolipoprotein E4; Asian People; Genetic Association Studies; Genetic Predisposition to Disease; Heterozygote; Humans; Macular Degeneration; Odds Ratio; Phenotype; Polymorphism, Genetic; Risk
PubMed: 28889998
DOI: 10.1016/j.arcmed.2017.08.002 -
PloS One 2014We investigated the serological association of Chlamydia pneumoniae infection with age-related macular degeneration (AMD). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We investigated the serological association of Chlamydia pneumoniae infection with age-related macular degeneration (AMD).
METHODS
A systematic review and meta-analysis was performed. PubMed, Embase, Web of Science and the Association of Research in Vision and Ophthalmology abstracts were searched to identify studies investigating the serological association of Chlamydia pneumoniae infection with age-related macular degeneration. The quality of original studies was assessed using the Newcastle-Ottawa scale. Heterogeneity was explored with meta-regression. The odds ratios (ORs) and standardized mean differences (SMD) of Chlamydia pneumoniae infection between AMD patients and controls were pooled.
RESULTS
In total, 9 studies met the inclusion criteria using the Newcastle-Ottawa scale scores ranging from 4 to 9. There was heterogeneity among studies due to a difference in the study designs and measurement of exposure to Chlamydia pneumoniae infection. The overall OR of Chlamydia pneumoniae infection with AMD was 1.11 (95% confidence interval: 0.78-1.57, P = 0.56). The overall SMD of antibody titer between AMD and control was 0.43 (95% confidence interval: -0.12 to 0.99, P = 0.13).
CONCLUSIONS
Evidence from the current published literature suggested no statistically significant association between Chlamydia pneumoniae infection and AMD.
Topics: Chlamydia Infections; Chlamydophila pneumoniae; Humans; Macular Degeneration; Serologic Tests
PubMed: 25062085
DOI: 10.1371/journal.pone.0103466 -
Journal of Clinical Medicine May 2020Since the efficacy of ranibizumab (RBZ), bevacizumab (BVZ) and aflibercept (AFB) is comparable in neovascular age-related macular degeneration (AMD), we conducted a... (Review)
Review
Comparative Safety of Bevacizumab, Ranibizumab, and Aflibercept for Treatment of Neovascular Age-Related Macular Degeneration (AMD): A Systematic Review and Network Meta-Analysis of Direct Comparative Studies.
BACKGROUND
Since the efficacy of ranibizumab (RBZ), bevacizumab (BVZ) and aflibercept (AFB) is comparable in neovascular age-related macular degeneration (AMD), we conducted a systematic review and meta-analysis to evaluate the long-term safety profiles of these agents, including ocular safety.
METHODS
Systematic review identifying randomized controlled trials (RCTs) comparing RBZ, BVZ and AFB directly published before March 2019. Serious ocular adverse events (SOAE) of special interest were endophthalmitis, pseudo-endophthalmitis, retinal pigment epithelium tear and newly identified macular atrophy.
RESULTS
Thirteen RCTs selected for meta-analysis (4952 patients, 8723 people-years follow-up): 10 compared RBZ vs. BVZ and three RBZ vs. AFB. There were no significant differences in almost all adverse events (systemic and ocular) between BVZ, RBZ and AFB in up to two years' follow-up. Macular atrophy was reported heterogeneously and not reported as SOAE in most trials.
CONCLUSIONS
Direct comparison of RBZ, BVZ and AFB safety profiles in the RCT network meta-analytical setting have not revealed a consistent benefit of these three commonly used anti-vascular endothelial growth factor (anti-VEGF) agents in AMD. Network model ranking highlighted potential benefits of RBZ in terms of a systemic safety profile; however, this appears a hypothesis rather than a conclusion. Newly identified macular atrophy is underestimated in RCTs-future real-world data should be focused on SOAE.
PubMed: 32443612
DOI: 10.3390/jcm9051522 -
American Journal of Ophthalmology Mar 2023Alzheimer disease (AD), a common form of dementia, shares several clinical and pathologic features with age-related macular degeneration (AMD). Epidemiologic reports on... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Alzheimer disease (AD), a common form of dementia, shares several clinical and pathologic features with age-related macular degeneration (AMD). Epidemiologic reports on the association of AMD with subsequent dementia or AD are inconsistent.
DESIGN
Systematic review and meta-analysis.
METHODS
The Meta-analysis of Observational Studies in Epidemiology reporting guidelines were applied. The Newcastle-Ottawa Scale was used to evaluate the risk of bias in the included cohort studies that examined the association of AMD with subsequent dementia or AD. We estimated the pooled hazard ratios (HRs) of dementia or AD using random effects model meta-analysis and subgroup analysis on different follow-up periods, AMD subtype, gender, age, study design, and methods to ascertain dementia or AD.
RESULTS
A total of 8 223 581 participants were included in 8 studies published during 2000-2021. The meta-analysis showed that AMD was significantly associated with subsequent dementia (pooled HR 1.22, 95% CI 1.01-1.47) or AD (pooled HR 1.21, 95% CI 1.03-1.43). Our secondary analysis revealed that the association was more noticeable in dry AMD than wet AMD.
CONCLUSIONS
Patients with AMD have higher risks of developing dementia or AD, and therefore identifying related comorbidities and retinal biomarkers is much warranted for older adults with AMD in ophthalmologic practice.
Topics: Humans; Aged; Alzheimer Disease; Wet Macular Degeneration; Geographic Atrophy; Comorbidity; Proportional Hazards Models
PubMed: 36375591
DOI: 10.1016/j.ajo.2022.11.005 -
Ophthalmology and Therapy Mar 2021Dark adaptation (DA) has been proposed as a possible functional biomarker for age-related macular degeneration (AMD). In this systematic review we aim to evaluate... (Review)
Review
INTRODUCTION
Dark adaptation (DA) has been proposed as a possible functional biomarker for age-related macular degeneration (AMD). In this systematic review we aim to evaluate current methodology used to assess DA in people with AMD, the evidence of precision in detecting the onset and progression of AMD, and the relationship between DA and other functional and structural measures.
METHODS
MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, PsycARTICLES were searched for studies published between January 2006 and January 2020 that assessed DA in people with AMD. Details of eligible studies including study design, characteristics of study population and outcomes were recorded. All included studies underwent quality appraisal using approved critical appraisal tools. This systematic review follows PRISMA guidelines (PROSPERO registration number: CRD42019129486).
RESULTS
Forty-eight studies were eligible for inclusion, reporting a variety of instruments and protocols to assess different DA parameters. Twenty of these studies used the AdaptDx (MacuLogix, Hummelstown, PA, USA) instrument and assessed rod-intercept time (RIT). Most of these reported that RIT was delayed in people with AMD and this delay worsened with AMD severity. Four studies, involving 533 participants, reported estimates of diagnostic performance of AdaptDx to separate people with AMD from visually healthy controls. DA has been compared to other measures of visual function, patient-reported outcome measures (PROMs) and structural measures. Ten studies specifically considered evidence that the presence of certain structural abnormalities was associated with impaired DA in AMD.
CONCLUSIONS
This systematic review indicates overwhelming evidence of reasonable quality for an association between impaired DA and AMD. Data on the repeatability and reproducibility of DA measurement are sparse. There is evidence that structural abnormalities such as reticular drusen are associated with prolongation of DA time. Fewer studies have explored an association between DA and other measures of visual function or PROMs. We found no studies that had compared DA with performance-based measures.
PubMed: 33565038
DOI: 10.1007/s40123-020-00323-0 -
JAMA Ophthalmology Jun 2022The association between residual subretinal fluid (SRF) and intraretinal fluid (IRF) and visual acuity following anti-vascular endothelial growth factor (VEGF) treatment... (Meta-Analysis)
Meta-Analysis
Association Between Visual Acuity and Residual Retinal Fluid Following Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration: A Systematic Review and Meta-analysis.
IMPORTANCE
The association between residual subretinal fluid (SRF) and intraretinal fluid (IRF) and visual acuity following anti-vascular endothelial growth factor (VEGF) treatment is not well understood.
OBJECTIVE
To examine the association of residual retinal fluid, SRF, and IRF with visual acuity following anti-VEGF treatment in patients with neovascular age-related macular degeneration (nAMD).
DATA SOURCES
A systematic literature search was performed from January 2005 to August 2021 using Ovid MEDLINE, Embase, and the Cochrane Library.
STUDY SELECTION
Peer-reviewed articles reporting on visual acuity stratified by the presence or absence of any residual SRF, IRF, or any retinal fluid at last study observation after intravitreal bevacizumab, ranibizumab, aflibercept, or brolucizumab in patients with nAMD were included. Studies that were noncomparative, included fewer than 10 eyes, or reported on other anti-VEGF agents were excluded.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers conducted data extraction and synthesis. The Cochrane risk of bias tool 2 and ROBINS-I were used to assess risk of bias and GRADE evaluation was conducted to assess certainty of evidence.
MAIN OUTCOMES AND MEASURES
Primary outcomes were BCVA at last study observation, change in BCVA from baseline, and retinal thickness at last study observation.
RESULTS
In this systematic review and meta-analysis, 11 studies (6 randomized clinical trials [RCTs]) comprising 3092 eyes were included in our analysis. Across all included studies, the BCVA of eyes with residual SRF was better than eyes without SRF (weighted mean difference [WMD], 3.1 letter score; 95% CI, 0.05 to 6.18; P = .05; GRADE, low certainty of evidence; 6 studies; 1931 eyes) but similar in RCTs (WMD, 2.7 letter score; 95% CI, -2.40 to 7.84; P = .30; GRADE, low certainty of evidence; 3 studies; 1406 eyes). The BCVA of eyes with residual IRF was worse than that of eyes without IRF (WMD, -8.2 letter score; 95% CI, -11.79 to -4.50; P < .001; GRADE, low; 7 studies; 2114 eyes).
CONCLUSIONS AND RELEVANCE
The findings suggest that the presence of residual SRF was associated with slightly better BCVA at last study observation; however, baseline differences in BCVA existed and this conclusion was primarily driven by 1 study. The presence of residual IRF was associated with substantially worse BCVA at last study observation and less improvement of BCVA from baseline. The conclusions are limited by the inclusion of data from observational studies, heterogeneity, and a low certainty of evidence.
Topics: Angiogenesis Inhibitors; Humans; Intravitreal Injections; Macular Degeneration; Ranibizumab; Receptors, Vascular Endothelial Growth Factor; Retina; Tomography, Optical Coherence; Vascular Endothelial Growth Factor A; Visual Acuity; Wet Macular Degeneration
PubMed: 35551359
DOI: 10.1001/jamaophthalmol.2022.1357 -
BMC Ophthalmology Dec 2023Age-related macular degeneration (AMD) is a significant cause of severe vision loss. The main purpose of this study was to identify mass spectrometry proteomics-based... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Age-related macular degeneration (AMD) is a significant cause of severe vision loss. The main purpose of this study was to identify mass spectrometry proteomics-based potential biomarkers of AMD that contribute to understanding the mechanisms of disease and aiding in early diagnosis.
METHODS
This study retrieved studies that aim to detect differences relate to proteomics in AMD patients and healthy control groups by mass spectrometry (MS) proteomics approaches. The search process was accord with PRISMA guidelines (PROSPERO database: CRD42023388093). Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes Pathway Analysis (KEGG) were performed on differentially expressed proteins (DEPs) in the included articles using the DAVID database. DEPs were included in a meta-analysis when their effect size could be computed in at least two research studies. The effect size of measured proteins was transformed to the log2-fold change. Protein‒protein interaction (PPI) analysis was conducted on proteins that were statistically significant in the meta-analysis using the String online database.
RESULTS
Eleven studies fulfilled the inclusion criteria, and 161 DEPs were identified. The GO analysis showed that AMD is significantly related to proteolysis, extracellular exosome and protein binding. In KEGG, the most significant pathway was the complement and coagulation cascades. Meta-analysis results suggested that eight proteins were statistically significant, and according to PPI results, the most significant four proteins were serotransferrin (TF), apolipoprotein A1 (APOA1), complement C3 (C3) and lipocalin-1 (LCN1).
CONCLUSIONS
Four possible biomarkers, TF, APOA1, C3 and LCN1, were found to be significant in the pathogenesis of AMD and need to be further validated. Further studies should be performed to evaluate diagnostic and therapeutic value of these proteins.
Topics: Humans; Proteomics; Macular Degeneration; Biomarkers; Proteins; Mass Spectrometry
PubMed: 38087257
DOI: 10.1186/s12886-023-03237-0 -
BMC Ophthalmology Jun 2018Conbercept is a novel vascular endothelial growth factor (VEGF) inhibitor for the treatment of wet age-related macular degeneration (AMD). This systematic review aims to... (Review)
Review
BACKGROUND
Conbercept is a novel vascular endothelial growth factor (VEGF) inhibitor for the treatment of wet age-related macular degeneration (AMD). This systematic review aims to assess the efficacy and safety of conbercept in the treatment of wet AMD.
METHODS
PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP database, and Wanfang database were searched from their earliest records to June 2017. We included randomized controlled trials (RCTs) evaluating the efficacy and safety of conbercept in wet AMD patients. Outcomes included the mean changes from baseline in best-corrected visual acuity (BCVA) score (primary outcome), central retinal thickness (CRT), plasma level of vascular endothelial growth factor (VEGF) over time, and the incidence of adverse events (AEs).
RESULTS
Eighteen RCTs (1285 participants) were included in this systematic review. Conbercept might improve BCVA compared to triamcinolone acetonide [MD = 0.11, 95% CI (0.08, 0.15)], and reduce CRT compared to the other four therapies (conservative treatment, ranibizumab, transpupillary thermotherapy, and triamcinolone acetonide). The incidence of AEs in patients receiving conbercept was significantly lower than those receiving triamcinolone acetonide [RR = 0.25, 95% CI (0.09-0.72)], but was similar to the other therapies. Conbercept seemed to be more effective than ranibizumab in lowering the plasma level of VEGF [MD = - 15.86, 95% CI (- 23.17, - 8.55)].
CONCLUSIONS
Current evidence shows that conbercept is a promising option for the treatment of wet AMD. Nevertheless, further studies are required to compare the efficacy, long-term safety and cost-effectiveness between conbercept and other anti-VEGF agents in different populations.
Topics: Dose-Response Relationship, Drug; Humans; Intravitreal Injections; Recombinant Fusion Proteins; Vascular Endothelial Growth Factor A; Visual Acuity; Wet Macular Degeneration
PubMed: 29902977
DOI: 10.1186/s12886-018-0807-1 -
Nutricion Hospitalaria Apr 2015nutritional components such as antioxidants may modify the risk of Macular Degeneration Age-related (AMD). This article is a systematic review of published studies... (Review)
Review
OBJECTIVE
nutritional components such as antioxidants may modify the risk of Macular Degeneration Age-related (AMD). This article is a systematic review of published studies relating to the modification of lifestyle, nutrition and vitamin intake to prevent or delay the onset or progression of Macular Degeneration Age-related (AMD).
RESULTS
the analysis of the results of research consulted shows that AMD is one of the most common causes of blindness in individuals over 55 years. AMD is characterized by decreased vision, metamorphopsias, macropsias, micropsias and central scotoma. Disease that must be diagnosed early because it can lead to irreversible blindness. Between components of the diet in many epidemiological studies have shown an inverse association with AMD and are reviewed in this paper are: vitamins (vitamin E and C), minerals (eg. zinc, selenium, manganese and copper) and carotenoids.
CONCLUSIONS
there is substantial evidence that can be applied nutritional support for patients with AMD. This requires determining the nutritional benefits of these nutrients (vitamins, minerals and carotenoids) or nutraceutical foods for health in this group of patients.
Topics: Dietary Supplements; Humans; Macular Degeneration; Micronutrients; Nutritional Status; Nutritive Value
PubMed: 26262695
DOI: 10.3305/nh.2015.32.1.9099 -
Frontiers in Pharmacology 2021Conbercept is a new anti-vascular endothelial growth factor (VEGF) drug. Here, we systematically conducted the efficacy, safety, compliance, and pharmacoeconomic... (Review)
Review
Conbercept for Treatment of Neovascular Age-Related Macular Degeneration and Visual Impairment due to Diabetic Macular Edema or Pathologic Myopia Choroidal Neovascularization: A Systematic Review and Meta-Analysis.
Conbercept is a new anti-vascular endothelial growth factor (VEGF) drug. Here, we systematically conducted the efficacy, safety, compliance, and pharmacoeconomic evaluation of intravitreal conbercept (IVC) compared with other treatments in patients with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), or pathologic myopia choroidal neovascularization (pmCNV). Databases of PubMed, Embase, Cochrane Library, ClinicalTrials.gov, SinoMed, China National Knowledge Infrastructure, and WanFang Data were systematically searched from the inception to July 27, 2021. Randomized clinical trials and pharmacoeconomic studies comparing IVC with control groups in adults with nAMD, DME, or pmCNV were reviewed and selected. Meta-analyses were performed using the fixed-effects model when pooled data were homogeneous. Heterogeneous data were analyzed using the random-effects model. Primary outcomes included visual improvement rate, mean change in visual acuity or best corrected visual acuity, and pharmacoeconomic outcomes. Additional outcomes were the mean change in fundus examination values, adverse events (AEs), quality-of-life measures, and number of injections. Among 3,591 screened articles, 22 original studies with 1,910 eyes of patients were finally included. For nAMD and DME, IVC was significantly associated with better visual acuity or best corrected visual acuity improvement and fundus quantitative measures than placebo, laser photocoagulation (LP), or intravitreal triamcinolone acetonide (IVT). However, IVC showed non-inferior efficacy to intravitreal ranibizumab (IVR) according to low quality of evidence, and there was lack of trials comparing the priority of IVC to other anti-VEGF regimens. No definitive increased risk of ocular or non-ocular AEs were observed in the study groups. All patients with AEs recovered after symptomatic treatments, and no severe AEs occurred. Patients treated with IVC might have higher quality-of-life scores than those in IVR in nAMD or LP in DME. Additionally, IVC showed cost-utility advantages in nAMD and cost-effectiveness advantages than IVR in pmCNV in China. IVC is well-tolerated and effective for improving vision acuity and quantitative measures in fundus condition in patients with nAMD and DME compared with LP, IVT, and placebo, but gains comparable efficacy to IVR. However, well-designed, large-sample, and long-term evaluation of IVC shall be conducted in additional studies worldwide.
PubMed: 34712132
DOI: 10.3389/fphar.2021.696201