Clinical Effectiveness Of Intravitreal Ranibizumab Combined With Retinal Laser Photocoagulation For RVO-ME:A Meta-analysis

Objective:Macular edema(ME)is one of the common complications of retinal vein occlusion(RVO),which can affect the visual acuity and visual quality of patients,and may cause irreversible visual impairment if not treated timely and correctly.At present,the main treatments for macular edema secondary to retinal vein occlusion(RVO-ME)include anti-VEGF drug injection,retinal laser photocoagulation and the combination of the two treatments.Here we evaluated the efficacy of intravitreal injection of Ranibizumab combined with retinal laser photocoagulation versus intravitreal Ranibizumab alone on RVO-ME treatment by Meta-analysis.Methods:The Chinese studies was retrieved from Wanfang,VIP and CNKI,while Embase,Web of science,Pubmed and Cochrance Library were used for English studies.The retrieval time was from the establishment of the database to December 2022,and sifting and data extraction of the retrieved literature.Meta-analysis was performed using RevMan 5.4 software.Results:Five randomized controlled trials were included in this study.A total of 254 eyes were affected,included 125 eyes in the Ranibizumab+laser group and 129 eyes in the Ranibizumab group.The Meta analysis is as follows:1.Best Corrected Visual Acuity(BCVA):Four of the five included studies reported in detail the change in BCVA,Three studies showed improved visual acuity levels in both the IVR+laser group and the IVR group was improved at 1 month follow-up,and the difference in BCVA was statistically significant[WMD=-0.05,95%CI(-0.09,-0.02),Z=2.79,P=0.005];The IVR+laser group is better than the simple IVR group.The BCVA statistics of 3 studies were included in the 3-month follow-up,and the results showed that the BCVA difference between the two groups was statistically significant[WMD=-0.04,95%CI(-0.07,-0.01),Z=2.27,P=0.02];The combined treatment group was superior to the IVR group alone.After 6 months of follow-up,2 studies were included,and the results showed no statistical significance in BCVA between the two groups[WMD=-0.05,95%CI(-0.15,0.04),Z=1.14,P=0.025].2.Central Macular Thickness(CMT):Four of the five included studies reported the changes of CMT in detail.Three studies showed that the thickness of central macular thickness decreased at 1 month of follow-up between the IVR+laser group and the IVR group alone,and there was no statistical difference in CMT[WMD=-11.80,95%CI(-65.27,41.66),Z=0.43,P=0.67];CMT was included in 3 studies followed up for 3 months,and the results showed that there was a statistically significant difference between the two groups[WMD=-29.63,95%CI(-52.83,-16.79),Z=4.52,P<0.00001];The IVR+laser group is better than the simple IVR group.The results of two studies with CMT at 6 months of follow-up showed a statistically significant difference between the two CMT groups[WMD=-57.24,95%CI(-74.03,-40.46),Z=6.68,P<0.00001],and the combined treatment group was superior to the IVR group alone.3.Number of injections:Among the 5 studies included,there was a statistically significant difference in the number of injections at the end of follow-up between the two groups reported in 2 studies[WMD=-1.12,95%CI(-1.89,-0.36),Z=2.88,P=0.004].The number of injections in the IVR+laser group was lower than that in the IVR single group.Conclusion:Intravitreal Ranibizumab combined with retinal laser photocoagulation could improve the best corrected visual acuity and reduce the central macular thickness in RVO-ME patients without serious complications.In addition,the combined retinal laser can reduce the number of Ranibizumab injections than intravitreal Ranibizumab alone.