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BMJ Open Feb 2021To give a comprehensive efficacy and safety ranking of different therapeutic regimens of ranibizumab for neovascular age-related macular degeneration (nAMD). (Meta-Analysis)
Meta-Analysis
Comparative efficacy and safety of different regimens of ranibizumab for neovascular age-related macular degeneration: a network meta-analysis of randomised controlled trials.
OBJECTIVE
To give a comprehensive efficacy and safety ranking of different therapeutic regimens of ranibizumab for neovascular age-related macular degeneration (nAMD).
DESIGN
A systematic review and network meta-analysis.
METHODS
The PubMed, Embase, Cochrane Central Register of Controlled Trials, and other clinical trial registries were searched up to 1 October 2019 to identify related randomised controlled trials (RCT) of different regimens of ranibizumab for nAMD. The primary efficacy outcome was the changes of best-corrected visual acuity (BCVA) at 1 year, the primary safety outcome was the incidence of severe ocular adverse events. Secondary outcomes such as changes of central retinal thickness (CRT) were evaluated. We estimated the standardised mean difference (SMD), ORs, 95% CIs, the surface under the cumulative ranking curves and the mean ranks for each outcome using network meta-analyses with random effects by Stata 14.0.
RESULTS
We identified 26 RCTs involving 10 821 patients with nAMD randomly assigned to 21 different therapeutic regimens of ranibizumab or sham treatment. Ranibizumab 0.5 mg (treat and extend, T&E) is most effective in terms of changes of BCVA (letters, SMD=21.41, 95% CI 19.86 to 22.95) and three or more lines of BCVA improvement (OR=2.83, 95% CI 1.27 to 4.38). However, it could not significantly reduce retreatment times compared with monthly injection (SMD=-0.94, 95% CI -2.26 to 0.39). Ranibizumab 0.5 mg (3+pro re nata)+non-steroidal anti-inflammatory drugs (NSAIDs) is most effective in reducing CRT and port delivery system of ranibizumab (100 mg/mL) could reduce the number of retreatment most significantly. All regimes have no more risk of severe ocular complications (including vitreous haemorrhage, rhegmatogenous retinal detachment, endophthalmitis, retinal tear and retinal pigment epithelium tear) or cardiocerebral vascular complications.
CONCLUSIONS
Ranibizumab 0.5 mg (T&E) is most effective in improving the visual outcome. The administration of topical NSAIDs could achieve additional efficacy in CRT reduction and visual improvement. Both interventions had acceptable risks of adverse events.
Topics: Angiogenesis Inhibitors; Bevacizumab; Humans; Intravitreal Injections; Macular Degeneration; Network Meta-Analysis; Ranibizumab; Treatment Outcome; Vascular Endothelial Growth Factor A
PubMed: 33550238
DOI: 10.1136/bmjopen-2020-040906 -
European Journal of Ophthalmology Nov 2021The incidence and risk factors of neovascular glaucoma (NVG) secondary proliferative diabetic retinopathy (PDR) after pars plana vitrectomy (PPV) are unclear and reports... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The incidence and risk factors of neovascular glaucoma (NVG) secondary proliferative diabetic retinopathy (PDR) after pars plana vitrectomy (PPV) are unclear and reports in the published literature are inconsistent. Therefore, a systematic review and meta-analysis were conducted to clarify the risk factors associated with neovascular glaucoma.
METHODS
PubMed, Embase, and The Cochrane Library were systematically searched without language limitations for studies related to NVG after PPV in PDR patients. We used R software to fit the correlation between incidence and the date of publication for studies and performed a Spearman analysis. For binary and continuous variables, the odds ratios (ORs) with 95% confidence intervals (CIs) were pooled, respectively, using Review Manager 5.3 (The Cochrane Collaboration).
RESULTS
Twenty-six studies with 5161 patients were included in our meta-analysis. The overall pooled incidence of NVG after PPV in PDR patients was 6% (95% CI, 0.05-0.07, -value < 0.00001). Pooled estimates indicated a positive correlation for NVG after PPV in PDR patients with higher baseline IOP (OR, 1.26; 95%CI,0.56-1.95, -value = 0.0004), preoperative iris neovascularization (INV) (OR, 5.66; 95% CI, 2.10-15.23, -value = 0.0006), preoperative or intraoperative combined cataract surgery (OR, 2.00; 95% CI, 1.15-3.46, -value = 0.01), postoperative vitreous hemorrhage (VH) (OR, 3.53; 95% CI, 1.63-7.66, -value = 0.001), and a negative correlation with age (OR, -2.90; 95%CI, -5.00 to -0.81, -value < 0.007).
CONCLUSION
Our systematic review and meta-analysis indicated that the main risk factors for NVG after PPV in PDR patients included higher baseline IOP, preoperative INV, preoperative or intraoperative combined cataract surgery, postoperative VH, and was negatively correlated with age.
Topics: Diabetes Mellitus; Diabetic Retinopathy; Glaucoma, Neovascular; Humans; Incidence; Risk Factors; Vitrectomy
PubMed: 33334171
DOI: 10.1177/1120672120980686 -
Acta Ophthalmologica Sep 2021To conduct a systematic review with network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing panretinal photocoagulation (PRP) versus anti-vascular...
Intravitreal anti-vascular endothelial growth factors, panretinal photocoagulation and combined treatment for proliferative diabetic retinopathy: a systematic review and network meta-analysis.
PURPOSE
To conduct a systematic review with network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing panretinal photocoagulation (PRP) versus anti-vascular endothelial growth factor (VEGF) treatment alone or in combination with PRP, for proliferative diabetic retinopathy (PDR).
METHODS
PubMed, Medline and Embase databases were searched for RCTs comparing PRP versus intravitreal anti-VEGF therapy and/or combined PRP and intravitreal anti-VEGF for PDR. The primary outcome measures were the mean best corrected visual acuity (BCVA) change and the regression of neovascularization. Mean change of central macular thickness (CMT), the subgroup analyses of patients without diabetic macular oedema (DME) and the rate of vitreous haemorrhage and vitrectomy were secondary outcomes. Frequentist NMAs were performed.
RESULTS
Twelve RCTs were included. For the 12-month mean BCVA change, NMA showed a better visual outcome in both the anti-VEGF group and combined group compared to PRP [anti-VEGF vs PRP, mean difference (MD) = 3.42; standard error (SE) = 1.5; combined vs PRP, MD = 3.92; SE = 1.65], with no difference between combined group and anti-VEGF (MD = -0.50; SE = 1.87). No difference in neovascularization regression was found between PRP and anti-VEGF alone or in combination with PRP, but there was significant inconsistency (p = 0.016). Subgroup analyses in patients without DME yielded no difference for the 12-month visual outcome between the three interventions, but with significant inconsistency (p = 0.005).
CONCLUSION
This NMA showed limited evidence of comparable efficacy in terms of neovascularization regression between PRP and anti-VEGF therapy alone or in combination with PRP, but better visual outcomes were associated with anti-VEGF use. Intravitreal anti-VEGF therapy could be a valid therapeutic option in association with PRP.
Topics: Angiogenesis Inhibitors; Diabetic Retinopathy; Humans; Intravitreal Injections; Laser Coagulation; Network Meta-Analysis; Visual Acuity; Vitrectomy
PubMed: 33326183
DOI: 10.1111/aos.14681 -
Frontiers in Pharmacology 2020To compare anti-vascular growth factor (anti-VEGF) pharmacotherapy with pan-retinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR).
Anti-Vascular Endothelial Growth Factor Therapy as an Alternative or Adjunct to Pan-Retinal Photocoagulation in Treating Proliferative Diabetic Retinopathy: Meta-Analysis of Randomized Trials.
AIM
To compare anti-vascular growth factor (anti-VEGF) pharmacotherapy with pan-retinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR).
METHOD
PubMed, Embase, Medline, the ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials were reviewed systemically. Randomized controlled trials (RCT) on anti-VEGF therapy versus PRP or anti-VEGF agent combined with PRP versus PRP for PDR are eligible to be included. Outcome measures were regression and recurrence of neovascularization, change in best corrected vision acuity, development of vitreous hemorrhage, and need for vitrectomy. A meta-analysis was conducted using RevMan (Cochrane Collaboration, Oxford, United Kingdom).
RESULTS
Twelve RCTs with a total of 1026 eyes were identified. The meta-analysis results showed that regression of neovascularization did not vary significantly among different treatment regimens (P=0.06), whereas the recurrence of new vessels was significantly lower in PRP monotherapy (P < 0.00001). The best corrected visual acuity was significantly improved with anti-VEGF monotherapy or in the combined group than in the PRP groups (P < 0.00001, P=0.04, respectively). Odds ratio for post-treatment vitreous hemorrhage and vitrectomy rate between anti-VEGF therapy and PRP were 0.65 (95% confidence interval, 0.45-0.95; P = 0.03), and 0.24 (95% confidence interval, 0.12-0.48; P < 0.0001).
CONCLUSION
Our meta-analysis indicates that anti-VEGF pharmacotherapy is associated with superior visual acuity outcomes and less PDR-related complications. However, there is insufficient evidence to suggest anti-VEGF therapy as an alternative to PRP.
PubMed: 32581805
DOI: 10.3389/fphar.2020.00849 -
Annals of Emergency Medicine Dec 2020
Meta-Analysis
Topics: Emergency Service, Hospital; Eye Abnormalities; Humans; Lens Subluxation; Physicians; Point-of-Care Systems; Retinal Detachment; Ultrasonography; Vitreous Detachment; Vitreous Hemorrhage
PubMed: 32563602
DOI: 10.1016/j.annemergmed.2020.04.036 -
Middle East African Journal of... 2020Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a rare retinal vasculopathy that might cause subretinal and/or vitreous hemorrhages. Although the primary...
Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a rare retinal vasculopathy that might cause subretinal and/or vitreous hemorrhages. Although the primary etiology is still unknown, choroidal neovascularization is mainly involved in the pathogenesis. The main risk factors are age and systemic hypertension. Ancillary testing such as fluorescein angiography, indocyanine green angiography and ultrasonography can be of great value for diagnosing this entity and distinguishing PEHCR from other lesions as choroidal melanoma and retinal vasoproliferative tumor. Various treatments have been reported including photocoagulation, cryotherapy, intravitreal injection of anti-vascular endothelial growth factor (Anti-VEGF) and surgical intervention as pars plana vitrectomy. This review handles an up-to-date perspective regarding PEHCR.
Topics: Angiogenesis Inhibitors; Coloring Agents; Cryotherapy; Fluorescein Angiography; Humans; Indocyanine Green; Intravitreal Injections; Laser Coagulation; Retinal Hemorrhage; Risk Factors; Tomography, Optical Coherence; Ultrasonography; Vascular Endothelial Growth Factor A; Vitrectomy; Vitreous Hemorrhage
PubMed: 32549717
DOI: 10.4103/meajo.MEAJO_85_20 -
Journal of Evidence-based Medicine May 2020To evaluate the latest evidence concerning the efficacy of conbercept on vitrectomy for proliferative diabetic retinopathy (PDR) and its efficacy compared to control and... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To evaluate the latest evidence concerning the efficacy of conbercept on vitrectomy for proliferative diabetic retinopathy (PDR) and its efficacy compared to control and other antivascular endothelial growth factor.
METHODS
We performed a systematic literature search on topics that assess the role of conbercept in patients undergoing vitrectomy for PDR from inception to November 2019, using PubMed, EuropePMC, Cochrane Central Database, ProQuest, ScienceDirect, and Clinicaltrials.gov. Two researchers independently searched literature, extracted data, and evaluated the risk of bias. RevMan 5.3 and StataMP 16 software were used to perform data analysis.
RESULTS
There were 699 cases (eyes) from eight studies. Baseline best-corrected visual acuity (BCVA) was better in the control group compared to conbercept group (mean difference [MD] = 0.13, I = 0%). A greater BCVA improvement was observed in the conbercept group after 1-month (MD = -0.27, I = 1%), 3-month (MD = -0.28, I = 0%), and 6-month (MD = -0.20, I = 78%) follow-up. The need for endodiathermy (odds ratio [OR] = 0.20, I = 0%) and silicone oil tamponade use (OR = 0.59, I = 72%) and intraoperative bleeding (OR = 0.11, I = 33%) was lower in conbercept group. Postoperative early (OR = 0.22, I = 0%) and late (OR = 0.47, I = 0%) vitreous hemorrhage was lower in conbercept group. There was no significant difference in BCVA improvement and intraoperative outcome between conbercept and ranibizumab.
CONCLUSIONS
Intravitreal conbercept was associated with a more significant BCVA improvement, better intraoperative outcome, and less postoperative vitreous hemorrhage compared to no conbercept.
Topics: Combined Modality Therapy; Diabetic Retinopathy; Humans; Recombinant Fusion Proteins; Treatment Outcome; Vascular Endothelial Growth Factor A; Vitrectomy
PubMed: 32167242
DOI: 10.1111/jebm.12379 -
JAMA Network Open Feb 2020Diagnosing posterior chamber ocular abnormalities typically requires specialist assessment. Point-of-care ultrasonography (POCUS) performed by nonspecialists, if... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Diagnosing posterior chamber ocular abnormalities typically requires specialist assessment. Point-of-care ultrasonography (POCUS) performed by nonspecialists, if accurate, could negate the need for urgent ophthalmologist evaluation.
OBJECTIVE
This meta-analysis sought to define the diagnostic test characteristics of emergency practitioner-performed ocular POCUS to diagnose multiple posterior chamber abnormalities in adults.
DATA SOURCES
PubMed (OVID), MEDLINE, EMBASE, Cochrane, CINAHL, and SCOPUS were searched from inception through June 2019 without restrictions. Conference abstracts and trial registries were also searched. Bibliographies of included studies and relevant reviews were manually searched, and experts in the field were queried.
STUDY SELECTION
Included studies compared ocular POCUS performed by emergency practitioners with a reference standard of ophthalmologist evaluation. Pediatric studies were excluded. All 116 studies identified during abstract screening as potentially relevant underwent full-text review by multiple authors, and 9 studies were included.
DATA EXTRACTION AND SYNTHESIS
In accordance with PRISMA guidelines, multiple authors extracted data from included studies. Results were meta-analyzed for each diagnosis using a bivariate random-effects model. Data analysis was performed in July 2019.
MAIN OUTCOMES AND MEASURES
The outcomes of interest were diagnostic test characteristics of ocular POCUS for the following diagnoses: retinal detachment, vitreous hemorrhage, vitreous detachment, intraocular foreign body, globe rupture, and lens dislocation.
RESULTS
Nine studies (1189 eyes) were included. All studies evaluated retinal detachment, but up to 5 studies assessed each of the other diagnoses of interest. For retinal detachment, sensitivity was 0.94 (95% CI, 0.88-0.97) and specificity was 0.94 (95% CI, 0.85-0.98). Sensitivity and specificity were 0.90 (95% CI, 0.65-0.98) and 0.92 (95% CI, 0.75-0.98), respectively, for vitreous hemorrhage and were 0.67 (95% CI, 0.51-0.81) and 0.89 (95% CI, 0.53-0.98), respectively, for vitreous detachment. Sensitivity and specificity were high for lens dislocation (0.97 [95% CI, 0.83-0.99] and 0.99 [95% CI, 0.97-1.00]), intraocular foreign body (1.00 [95% CI, 0.81-1.00] and 0.99 [95% CI, 0.99-1.00]), and globe rupture (1.00 [95% CI, 0.63-1.00] and 0.99 [95% CI, 0.99-1.00]). Results were generally unchanged in sensitivity analyses of studies with low risk of bias.
CONCLUSIONS AND RELEVANCE
This study suggests that emergency practitioner-performed ocular POCUS is an accurate test to assess for retinal detachment in adults. Its utility in diagnosing other posterior chamber abnormalities is promising but needs further study.
Topics: Eye Diseases; Humans; Point-of-Care Systems; Posterior Eye Segment; Retinal Detachment; Ultrasonography
PubMed: 32074291
DOI: 10.1001/jamanetworkopen.2019.21460 -
Journal of Ophthalmic Inflammation and... Jan 2020This study aims to determine if the intravitreal dexamethasone implant (DEX implant, Ozurdex; Allergan, Inc., Irvine, California) is effective for treating intermediate,...
BACKGROUND
This study aims to determine if the intravitreal dexamethasone implant (DEX implant, Ozurdex; Allergan, Inc., Irvine, California) is effective for treating intermediate, posterior, and panuveitis as a monotherapy or adjunctive treatment to systemic immunomodulatory therapies.
METHODS
A systematic review using MEDLINE, EMBASE, and PubMed database searches was conducted with the Oxford Centre for Evidence-based Medicine Levels of Evidence criteria to select publications. Available background information and patient data from each study was tabulated. Outcomes studied were central retinal thickness (CRT), best corrected visual acuity, intraocular inflammation (anterior chamber cells, vitreous haze), number of patients with prior and concomitant immunomodulatory treatments, intraocular pressure (IOP) elevation (≥ 25 mmHg), and other adverse effects associated with the implant.
RESULTS
One hundred ninety-five (61.51%) patients had previous immunomodulatory treatment while 232 (64.8%) were treated with concomitant immunomodulatory therapy with the DEX implant. CRT decreased by an average of 198.65 μm (42.74%). Visual acuity improved to an average of 0.451 (logMAR) or 20/57 (Snellen) which is a 43.11% improvement from baseline. One hundred seventy-three (59%) of eyes were quiescent at the end of the trials, of which 40 (13.7%) previously inflamed eyes became quiescent. Elevated IOP occurred in 91 (20.6%). The most common adverse events were cataract/posterior subcapsular opacities in 47 (11.03%) patients and conjunctival hemorrhage in 24 (5.44%) patients.
CONCLUSIONS
The DEX implant is an effective medication for the treatment of posterior segment uveitis, uveitic macular edema, and results in improved visual acuity. Development of elevated IOP and cataract should be closely monitored as they are tangible risks associated with the DEX implant. This study was not able to determine whether the DEX implant was more effective as a monotherapy or as an adjunctive therapy to systemic immunomodulatory treatment.
PubMed: 31925591
DOI: 10.1186/s12348-019-0189-4 -
Experimental and Therapeutic Medicine Jan 2019The aim of the present systematic review was to assess the efficacy of laser therapy for ischemic central retinal vein occlusion (CRVO). Relevant studies were retrieved...
The aim of the present systematic review was to assess the efficacy of laser therapy for ischemic central retinal vein occlusion (CRVO). Relevant studies were retrieved by searching the PubMed, Embase, Chinese Biomedical Literature Database and, Chinese Science and Technology Periodicals databases using a combination of key words, including 'central retinal vein obstruction', 'CRVO', 'laser' and 'panretinal photocoagulation'. The titles, abstracts and full texts were screened by two independent reviewers and studies were selected according to specific inclusion criteria. Data were extracted and the quality of each study was graded using the Grading of Recommendations, Assessment, Development and Evaluation or Methodological Index for Non-Randomized Studies (MINORS) criteria. A total of 1,187 abstracts were retrieved, and finally, 11 clinical studies were selected, including 534 cases of CRVO. Of these, 8 studies compared the efficacy of laser therapy with other treatments for CRVO, two studies compared the efficacy of laser therapy and drug treatment for CRVO and one study compared the efficacy of early laser therapy with standard laser therapy (regular examinations and laser therapy performed as soon as neovascularization was identified) for CRVO. Among them, the results of five studies demonstrated that panretinal photocoagulation (PRP) for the prevention of iris neovascularization and neovascular glaucoma is inefficient regarding the improvement of visual acuity. A total of 10 studies indicated that laser therapy achieved better outcomes in neovascularization of the retina, optic disc neovascularization and iris neovascularization, neovascular glaucoma, vitreous hemorrhage, changes in the visual field, macular edema, macular thickness and intraocular pressure. Of note, it was indicated that laser photocoagulation prevents the severe vascular complications of CRVO. In addition, in the eyes of patients receiving PRP for the treatment of ischemic CRVO, significant reductions in corneal sub-basal nerve plexus parameters and average peripapillary retinal nerve fiber layer thickness were observed. Furthermore, laser photocoagulation was able to increase retinal blood flow in eyes with ischemic CRVO.
PubMed: 30651879
DOI: 10.3892/etm.2018.7034