Anti-Vascular Endothelial Growth Factors In The Treatment Of Macular Oedema Secondary To Central Retinal Vein Occlusion:a Meta-analysis

Background Central retinal vein occlusion (CRVO) is a common retinal vasculardisease. Macular oedema secondary to CRVO is a major threat of visual function.Intraocular anti-vascular endothelial growth factor (VEGF) injection is a promisingtreatment since it can relieve macular oedema and improve visual acuity significantly,but lacks clinical evidence of its safety and efficacy.Design Meta-analysis.Participants Patients suffered from macular oedema secondary to CRVO involvedin previously reported randomized controlled trials (RCTs) comparing intravitrealanti-VEGF versus sham injections.Methods A comprehensive search in MEDLINE, CENTRAL, and EMBASE wasconducted for reports published by April2013. A meta-analysis of the retrieved datawas conducted in RevMan5.2software.Main Outcome Measures Primary outcome measures were changes inbest-corrected visual acuity (BCVA) and central retinal thickness (CRT) frombaseline. Secondary outcome measures were the proportion of eyes changing15ormore letters on the Early Treatment in Diabetic Retinopathy Study (ETDRS) chart,the proportion of eyes with Snellen equivalent BCVA≥20/40or≤20/200, theproportion of eyes without residual oedema, the proportion of eyes progressing toocular neovascularization and a change in the National Eye Institute Visual FunctionQuestionnaire-25(NEI VFQ-25). Severe adverse events (SAEs) were summarized toassess safety.Results Six randomized RCTs involving a total of940eyes were conducted. Theanti-VEGF group exhibited more significant and more rapid BCVA improvement andCRT reduction than did controls. The mean changes in BCVA and CRT at six monthsfrom baseline for the anti-VEGF group were15.2ETDRS letters (95%confidence interval [CI]=12.0-18.5, P<0.00001) and-242.2μm(95%CI=-312.6to-171.8, P <0.00001), respectively. SAE incidence was similar between the groups.Conclusions Intravitreal anti-VEGF injections were safe and effective for macular oedema secondary to CRVO. The efficacy was rapid, significant and robust. This evidence is clinically valuable. Further trials are needed to determine the detailed indications and therapeutic regimens of anti-VEGF treatments.