Different Treatments For Macular Edema Secondary To Branch Retinal Vein Occlusion: A Network Meta-analysis

Objectives We conducted a network meta-analysis to evaluate the efficacy and safety of different treatments for the macular edema secondary to branch retinal vein occlusion.Methods Pubmed,EMBASE,Cochrane Library,VIP,CNKI and Wangfang database were searched for all relevant studies up to 10 May 2017.The research object was the patients suffering from macular edema secondary to branch retinal vein occlusion,and the interventions were macular grid laser photocoagulation,triamcinolone acetonide,dexamethasone,fluocinolone acetonide,pegaptanib,ranibizumab,bevacizumab,aflibercept,conbercept and intravitreal injections combined with laser.Only randomized controlled trials were included and the following times should be at least 6 months.Primary outcome was mean improvement in best corrected visual acuity,while secondary outcomes were the decrease of central retinal thickness,and adverse events included ocular hypertension,cataract and endophthalmitis.The retrieved documents were screened and included based on the inclusion and exclusion criteria of this research requirement,and to assess the quality of the literature according to Cochrane quality assessment criteria.R 3.3.2,GeMTC 0.14.3 and Stata 12.1 were used to do the data processing and network meta-analysis to evaluate the efficacy and safety of the above treatments.Results 2410 relevant studies were screened out and 14 trails were included in the research,containing 2059 patients.The interventions were aflibercept,bevacizumab,bevacizumab+laser,dexamethasone,dexamethasone+laser,macular grid laser photocoagulation,ranibizumab,ranibizumab+laser and sham intervention.The overall risk of bias is moderate in all 14 trials.According to network meta-analysis,the mean difference and 95% credible intervals ordered by changes of best correct visual acuity at 6 month compared to sham intervention were as followed: aflibercept 13.57(6.01,21.58),ranibizumab+laser 12.95(8.23,18.29),bevacizumab+laser11.78(5.70,19.40),ranibizumab10.93(6.90,14.99),bevacizumab8.00(2.44,13.82),dexamethasone+laser5.05(-3.97,13.96),laser3.38(-1.69,9.09),dexamethasone2.55(-1.37,6.28).Conclusion Anti-vascular endothelial growth factors can effectively reduce macular edema from branch retinal vein occlusion and improve visual acuity,with less adverse reactions.