比较雷珠单抗和贝伐珠单抗对新生血管AMD的疗效

目的：比较玻璃体内注射雷珠单抗与贝伐珠单抗对年龄相关性黄斑变性（ age-related macular degeneration, AMD）的疗效,治疗方案必要时采用。 方法：回顾性分析63例63眼（雷珠单抗治疗组35眼,贝伐珠单抗治疗组28眼）新确诊新生血管年龄相关性黄斑变性患者的资料。治疗12 mo后随访,分析比较两组患者的最佳矫正视力（ BCVA）和黄斑中心凹厚度（ CFT）。采用双尾t检验和单因素方差分析比较两组最佳矫正视力和黄斑中心凹厚度的变化。 结果：雷珠单抗治疗组35眼和贝伐珠单抗治疗组28眼均完成12 mo随访,并记录数据。雷珠单抗治疗组最佳矫正视力均值增加0.1 logMAR;相反,贝伐珠单抗治疗组最佳矫正视力均值下降0.06logMAR（P=0.01）。雷珠单抗治疗组13眼（37%）和贝伐珠单抗治疗组4眼（14%）最佳矫正视力至少增加0.3logMAR。雷珠单抗治疗组平均黄斑中心凹厚度减少41.6μm,贝伐珠单抗治疗组减少8.1μm（P=0.003）。两组平均注射次数是4.46次和4.11次（P〉0.05）。 结论：玻璃体内注射雷珠单抗组在视力和消水肿方面疗效优于贝伐珠单抗组。但是,两种药的疗效和安全性还需要随机的长期临床试验来验证。     

比较贝伐单抗和MMC辅助小梁切除术效果的Meta分析

目的：比较贝伐单抗与丝裂霉素C( mitomycin C,MMC)辅助小梁切除术治疗青光眼的有效性和安全性。
　　方法：计算机检索 PubMed、CBM、VIP、CNKI 和万方数据库,查找所有比较贝伐单抗与MMC辅助小梁切除术治疗青光眼效果的随机对照试验( randomized controlled trials, RCTs),检索时限均为建库至2016-06-30。同时按纳入和排除标准由两名评价员独立进行RCT的筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。结果：共纳入4项研究,总计286眼(贝伐单抗组143眼, MMC组143眼)。 Meta分析结果显示：(1)有效性：贝伐单抗组与MMC组术后随访末次眼压( intraocular pressure, IOP)(WMD=2.21,95% CI：-0.17~4.58,P=0.07)和手术完全成功率(OR=0.69,95% CI：0.26~1.81,P=0.45)均无统计学差异;两组患者随访末次抗青光眼药物使用数量(OR=0.12,95% CI：-0.15~0.39,P=0.39)相似,结果无统计学意义。(2)安全性：两组患者术后并发症发生率相同,无统计学差异,低眼压(OR=0.7,95% CI：0.12~4.05, P=0.69)、滤泡漏(OR=1,95% CI：0.21~4.74,P=1)、包囊型滤泡(OR=1.15,95% CI：0.38~3.44,P=0.81)、脉络膜脱离(OR=1.22,95% CI：0.29~5.22,P=0.78)和白内障(OR=1.15,95% CI：0.38~3.44,P=0.81)。
　　结论：小梁切除术联合贝伐单抗与联合MMC治疗青光眼具有相似的疗效和安全性,贝伐单抗并不能更有效地降低眼压,临床医师应根据患者疾病特点选择适合药物辅助手术。     

光动力学疗法联合雷珠单抗对比雷珠单抗治疗湿性AMD有效性和安全性的Meta分析

目的 系统评价光动力学疗法联合雷珠单抗对比雷珠单抗单独治疗湿性AMD的有效性和安全性.方法 Meta分析.检索美国国立医学图书馆、荷兰医学文摘、循证医学数据库、中国期刊全文数据库、万方数据库,共纳入6篇随机对照试验,共626眼,其中单纯注药组323眼,联合治疗组303眼.遵循Cochrane Handbook 5.0质量评价原则评价纳入研究的质量,然后采用Revman 5.0软件进行统计学处理.结果 Meta分析结果显示：①最佳矫正视力（EDTRS）：治疗1年后,单纯注药组视力改善效果好于联合治疗组,差异有统计学意义[WMD=-2.84,95％CI（0.25～5.43）,P＜0.05].其中单纯注药组比联合治疗组最佳矫正视力提高≥15个视标的发生率更高,差异有统计学意义[W MD=0.66,95％CI（0.45～0.96）,P＜0.05];而2组最佳矫正视力丢失≥15个视标的发生率比较,差异无统计学意义[WMD=1.37,95％CI（0.78～2.41）,P＞0.05].②中央视网膜厚度：治疗1年后,2组视网膜厚度变化比较,差异无统计学意义[WMD=-3.17,95％CI（-25.64～31.97）,P＞0.05].③病灶大小：治疗1年后,2组病灶大小变化比较,差异无统计学意义[WMD=0.24,95％CI（-0.38～0.86）,P＞0.05].④注药次数：治疗1年后,2组注药次数比较,差异无统计学意义[W MD=-1.00,95％CI （-2.56～0.56）,P＞0.05].⑤并发症：视网膜出血：联合治疗组比单纯注药组视网膜出血的发生率更高,差异有统计学意义[RR=2.65,95％CI（1.04～6.71）,P＜0.05].结论 单独雷珠单抗相比光动力学疗法联合雷珠单抗治疗湿性AMD改善最佳矫正视力的效果更好,但在视网膜厚度、病灶大小、注药次数方面,两者的差异无统计学意义.联合治疗并发视网膜出血的风险较高.     

玻璃体腔注射雷珠单抗与玻璃体腔注射雷珠单抗联合光动力疗法治疗息肉样脉络膜血管病变的视力预后比较

目的 比较玻璃体腔注射雷珠单抗（商品名：Lucentis)与玻璃体腔注射雷珠单抗联合光动力疗法（PDT）治疗息肉样脉络膜血管病变（PCV）的视力预后。方法 回顾性临床研究。临床确诊为PCV的36例患者36只眼分为玻璃体腔注射雷珠单抗（单纯注射）组与玻璃体腔注射雷珠单抗联合PDT（联合治疗）组,每组各18例18只眼。单纯注射组患者玻璃体腔注射10 mg/ml雷珠单抗0.05 ml（含雷珠单抗0.5 mg),注射后1个月按需给药;联合治疗组患者先行常规PDT治疗,3 d后再给予玻璃体腔注射雷珠单抗,注射方法同单纯注射组。联合治疗3个月后根据检查结果 确定是否需要重复注射治疗。治疗后随访时间至少12个月,观察患者的并发症发生情况;对比分析两组患者治疗前及治疗后最小分辨角对数（logMAR）最佳矫正视力（BCVA）的变化情况。结果 所有患者在治疗及随访过程中无视网膜脱离、持续高眼压、视网膜裂孔、眼内炎、全身不良反应等并发症发生。单纯注射组、联合治疗组平均注射雷珠单抗次数分别为(3.00±0.84)、（1.89±0.68）次;两组平均注射雷珠单抗次数比较,差异有统计学意义（t=4.370,P=0.000）。单纯注射组、联合治疗组患者治疗后1、3个月logMAR BCVA比较,差异无统计学意义（t=0.668、0.940,P＞0.05）。单纯注射组、联合治疗组患者治疗后6、12个月logMAR BCVA比较,差异有统计学意义（t=2.188、2.547,P＜0.05）。末次随访时,单纯注射组、联合治疗组logMAR BCVA均较治疗前明显提高,差异有统计学意义（t=3.351、9.408,P=0.012、0.000）。单纯注射组患眼中,视力提高3只眼,占16.7%;视力稳定13只眼,占72.2%;视力下降2只眼,占11.1%。联合治疗组患眼中,视力提高4只眼,占22.2%;视力稳定13只眼,占72.2%;视力下降1只眼,占5.6%。结论 玻璃体腔注射雷珠单抗与玻璃体腔注射雷珠单抗联合PDT治疗PCV均可明显提高患者视力。治疗后3个月内两种治疗方式的视力预后无明显差别;治疗后6~12个月,玻璃体腔注射雷珠单抗联合PDT治疗者视力预后优于玻璃体腔注射雷珠单抗治疗者。     

联合方案治疗BRVO-ME远期疗效的Meta分析

目的:评价视网膜激光光凝联合玻璃体腔注射雷珠单抗与单纯雷珠单抗治疗视网膜分支静脉阻塞继发黄斑水肿(BRVO-ME)的远期疗效及安全性。方法:系统检索Embase、The Cochrane Library、PubMed、中国期刊全文数据库(CNKI)、万方数据库(Wanfang Database)、维普中文科技期刊数据库(VIP)关于激光和雷珠单抗治疗BRVO-ME的随机对照临床研究文献,对纳入研究进行风险评估、提取数据指标。采用RevMan 5.3软件进行数据分析,采用漏斗图评价发表偏倚。结果:共纳入7项研究,641眼。激光联合雷珠单抗组和单纯雷珠单抗组患者的最佳矫正视力(BCVA)在治疗后12mo[WMD=0.00,95%CI(-0.13,0.14),P=0.95]和24mo[WMD=0.05,95%CI(-0.12,0.22),P=0.57]变化均无明显差异。两组在治疗12mo[WMD=-7.67,95%CI(-54.58,39.24),P=0.75]和24mo[WMD=12.21,95%CI(-81.68,106.09),P=0.80]黄斑中心凹厚度的变化无明显差异。两组在12、24mo的雷珠单抗注药次数及最终不良事件发生情况方面亦无统计学差异。结论:激光联合雷珠单抗相较单纯雷珠单抗治疗BRVO-ME,在视力和黄斑中心凹厚度方面的远期结果无明显差异,在雷珠单抗的注药次数和安全性方面也无较大差距。     

康柏西普与雷珠单抗治疗视网膜静脉阻塞继发黄斑水肿的Meta分析

目的:系统比较康柏西普和雷珠单抗治疗视网膜静脉阻塞继发黄斑水肿(RVO-ME)的疗效和安全性,为临床指导用药提供依据。方法:全网综合检索关于玻璃体腔内注射康柏西普和雷珠单抗治疗RVO-ME的临床随机对照试验文献,对纳入文献进行风险评估,并提取相关数据指标。采用RevMan 5.3软件进行数据分析,并采用Egger检验评价发表偏倚。结果:本研究纳入文献14篇,共计1 350眼。康柏西普组和雷珠单抗组患者最佳矫正视力(BCVA)在治疗后2wk,2、3、6mo无明显差异,但在治疗后1wk[WMD=-0.03,95%CI(-0.05,-0.02),P<0.0001]和1mo[WMD=-0.03,95%CI(-0.04,-0.01),P=0.001]康柏西普组患者BCVA相比雷珠单抗组较好。两组患者黄斑中心凹视网膜厚度(CMT)在治疗后1、2wk,1、2、3mo无明显差异,但在治疗后6mo[WMD=-28.77,95%CI(-54.23,-3.31),P=0.03]康柏西普组患者黄斑水肿减轻程度相比雷珠单抗组更明显。玻璃体腔内注射康柏西普和雷珠单抗产生的不良反应情况无差异[OR=0.95,95%CI(0.57,1.57),P=0.84],但康柏西普的平均注射次数较少。结论:康柏西普和雷珠单抗均可改善BCVA,降低CMT,二者在后期视力改善方面无差异,但康柏西普在改善CMT方面更具优势,且注射次数少,费用低。     

雷珠单抗治疗重度视力损害渗出型年龄相关性黄斑变性患者的疗效观察

目的观察玻璃体腔注射雷珠单抗治疗重度视力损害渗出型年龄相关性黄斑变性(AMD)患者的疗效。方法回顾性分析在我院确诊为渗出型AMD、最佳矫正视力(BCVA)<0.05并接受雷珠单抗玻璃体腔注射的46例患者(47只眼)的临床资料。所有患者均行玻璃体腔注射雷珠单抗治疗,治疗后随访1~8个月,平均随访(4.09±2.25)个月。对比分析玻璃体腔注射雷珠单抗治疗前后BCVA、黄斑中心视网膜厚度(CRT)、病变最厚处视网膜厚度(MRT)的变化及不良反应的发生情况。结果至末次随访时,47只眼中,视力提高29只眼,占61.7%;视力稳定15只眼,占31.9%;视力下降3只眼,占6.4%。治疗后,平均CRT由治疗前的(301.30±84.57)μm降低为(211.27±87.03)μm;与治疗前相比,平均CRT下降(90.03±33.99)μm,差异有统计学意义(t=4.336,P<0.01);MRT由(529.04±174.63)μm降低为(421.86±95.78)μm;与治疗前相比,平均MRT下降(107.17±42.46)μm,差异有统计学意义(t=3.984,P<0.01)。结论雷珠单抗治疗重度视力损害渗出型AMD患者具有较好的疗效。     

阿柏西普与雷珠单抗治疗湿性黄斑变性的效果比较

目的比较阿柏西普与雷珠单抗玻璃体内注射治疗湿性年龄相关性黄斑变性(AMD)的临床效果。方法前瞻性随机对照研究。收集2019年4至6月郑州市第二人民医院湿性AMD 79例(79眼)随机分为两组。阿柏西普组, 39例(39眼), 玻璃体内注射阿柏西普;雷珠单抗组, 40例(40眼), 玻璃体内注射雷珠单抗。术后6个月及12个月随访观察, 比较两组的治疗效果。结果术后6个月及12个月, 两组视力均优于术前(t=5.680, 5.310;均P<0.001), 但两组间差异无统计学意义(t=1.420, 1.066;P=0.160, 0.290)。两组术后黄斑中心区厚度(CMT)均低于术前(t=6.900, 7.499;均P<0.001), 但两组间差异无统计学意义(t=0.262, 0.412;P=0.794, 0.681)。阿柏西普组的平均注射次数(7.63±1.25)次, 少于雷珠单抗组的(8.72±1.62)次(t=-3.342, P=0.002)。结论玻璃体内注射阿柏西普或雷珠单抗治疗湿性AMD均能降低CMT, 提高视力, 阿柏西普注射次数较少。     

玻璃体腔注射雷珠单抗和康柏西普治疗渗出型年龄相关性黄斑变性疗效比较

目的：探讨玻璃体腔注射雷珠单抗和康柏西普治疗渗出型年龄相关性黄斑变性(ARMD)疗效,并分析对患者最佳矫正视力(BCVA)、中心凹视网膜厚度(CRT)和并发症的影响。

方法：回顾性分析。收集2017-01/2020-01我院收治的渗出型ARMD患者60例60眼临床资料,按治疗药物不同分为玻璃体腔注射雷珠单抗组30眼和玻璃体腔注射康柏西普组30眼。比较两组患者治疗前,治疗1、2、3mo时患者BCVA、CRT、脉络膜新生血管变化和并发症发生情况。

结果：治疗后1、2、3mo,两组患者BCVA(LogMAR)较治疗前显著改善(P<0.05),CRT较治疗前显著降低(P<0.05),且玻璃体腔注射康柏西普组治疗1、2、3mo的CRT显著低于玻璃体腔注射雷珠单抗组(P<0.05); 两组脉络膜新生血管恢复情况和并发症发生情况比较无明显差异(P>0.05)。

结论：玻璃体腔注射雷珠单抗和康柏西普治疗渗出型ARMD均可取得较好的疗效,二者在改善视力方面无明显差异,但康柏西普治疗渗出型ARMD在降低CRT方面更具有明显优势。     

贝伐单抗联合曲安奈德与单独贝伐单抗玻璃体腔内注射治疗糖尿病性黄斑水肿的Meta分析

背景临床上贝伐单抗（bevacizumab）和曲安奈德（TA）已广泛用于糖尿病性黄斑水肿（DME）的治疗,但由于二者单独治疗都存在一些弊端,因此一些学者尝试二者联合治疗,但其疗效存在争议。目的系统评价玻璃体腔内注射bevacizumab联合TA与单独注射bevacizumab治疗DME短期疗效的差异。方法用循证医学方法检索美国国立医学图书馆、荷兰医学文摘、循证医学数据库、中国期刊全文数据库中有关bevacizumab联合TA与单独注射bevacizumab治疗DME短期疗效的随机对照临床试验（RCTs）文献进行二次分析,遵循Cochrane Handbook 5．0质量评价原则评价纳入研究的质量。分析的疗效结局指标包括中央黄斑厚度（CMT）及最佳矫正视力（BCVA）变化,安全性评价指标为局部和全身不良事件。连续变量的计量资料采用加权均数差（WMD）作为合并效应量,计数资料采用相对危险度（RR）为疗效分析统计量,采用Cochrane协作网的Revman 5．0软件对效应合并量进行统计学处理。结果共纳入9篇RCTs文献,共665眼。Meta分析结果显示,治疗后12周、18周时bevacizumab联合TA组CMT改善程度优于单独注射bevacizumab组,差异均有统计学意义（WMD=-44．69,95％CI：25．27～64．11,P〈0．000001;WMD=-66．86,95％CI：40．67—93．05,P〈0．000001）,而在治疗后6周及6个月时两组间差异无统计学意义（WMD=-15．40,95％CI：-4．04—34．85,P=0．12;WMD=-2．57,95％CI：-19．62—24．75,P=0．82）。治疗后6周时bevacizumab联合TA组BCVA（LogMAR值）的改善值优于单独注射bevacizumab组,差异有统计学意义（WMD=-0．04,95％CI：-0．08--0．00,P=0．05）,而在治疗后12周、18周及6个月时两组间差异均无统计学意义（WMD=-0．04,95％CI：-0．12～0．05,P：0．36;WMD=-0．04,95％CI：-0．11～0．03,P=0．28;WMD=0．03,95％CI：-0．05～0．12,P=0．45）。两种治疗方式间术后一过性前房反应的发生率差异无统计学意义（RR=0．89,95％CI：0．49～1．60,P=0．70）,bevacizumab联合TA组继发性高眼压的发生率为（30／327）,单独注射bevacizumab组治疗眼未发生继发性高眼压。结论Bevacizumab联合TA玻璃体腔内注射治疗DME在减轻黄斑水肿方面疗效明显优于单独注射bevacizumab组,但两种方法在改善BCVA方面效果无明显差异。Bevacizumab联合TA玻璃体腔内注射后发生继发性高眼压的风险高于单独注射bevacizumab应用组,但用降眼压药物后眼压能够控制。     

Comparison of bevacizumab and ranibizumab in age-related macular degeneration:a systematic review and meta-analysis

AIM: To compare the effectiveness and safety between bevacizumab and ranibizumab in the treatment of age-related macular degeneration (AMD) through a systematic review and meta-analysis.METHODS:We performed a comprehensive search of randomized controlled trials (RCTs), non-RCTs, case-control and cohort studies that compared bevacizumab and ranibizumab using PubMed and the Cochrane Library. After the related data were extracted by two investigators independently, pooled weighted mean differences (WMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a random-effects or a fixed-effects model.RESULTS:A total of four RCTs involving 1927 patients and eleven retrospective case series involving 2296 patients were included. For the primary outcomes, no significant differences were found between ranibizumab group and bevacizumab group in visual acuity (WMD:-0.04; 95%CI:-0.08 to 0.00; P=0.06), best corrected visual acuity (WMD:-0.05; 95%CI:-0.10 to 0.00; P=0.05), retina thickness (WMD:-4.69; 95%CI:-13.15 to 3.76; P=0.86) and foveal thickness (WMD:10.91; 95%CI:-14.73 to 36.56; P=0.40). The pooled analyses in the evaluation of safety showed that compared to bevacizumab, ranibizumab was associated with decreased risks of ocular inflammation (RR:0.45; 95% CI:0.23 to 0.89; P=0.02) and venous thrombotic events (RR:0.27; 95%CI:0.08 to 0.89; P=0.03). However, there were no significant differences observed in deaths (P=0.69) and arterial thromboembolic events (P=0.71) between the two groups.CONCLUSION:With equal clinical efficacy, ranibizumab was found to be associated with less adverse events compared to bevacizumab, indicating that ranibizumab might be a safer management.     

Comparison of conbercept and ranibizumab for the treatment efficacy of diabetic macular edema: a Meta-analysis and systematic review

AIM: To evaluate the efficacy of intravitreal injection of conbercept (IVC) and ranibizumab (IVR) in patients with diabetic macular edema. METHODS: Reviewers have searched 12 databases, including PubMed, Medline, EMBASE, Web of Science, Springer, ScienceDirect, OVID, Cochrane Library, ClinicalTrials.gov, cqVIP, WanFangdata and China National Knowledge Infrastructure (CNKI), up to December 28, 2018. RevMan 5.3 (Cochrane Library Software, Oxford, UK) was employed for statistical analysis. Fixed and random effects models were applied to assess heterogeneity. Odds ratio (OR) was applied for dichotomous variables; weighted mean difference (WMD) was applied for continuous variables. The confidence interval (CI) was set at 95%. Central macular thickness (CMT) and best-corrected visual acuity (BCVA) were employed to analyze the improvement of DME patients. Inclusion criteria for picking out studies were retrospective studies and randomized controlled trials (RCTs) that compared IVC and IVR for the treatment of diabetic macular edema. RESULTS: Four retrospective studies and five RCTs were included with a total of 609 patients. No statistically significant difference was observed in mean CMT and mean BCVA in the baseline parameters [BCVA (WMD: -0.48; 95%CI: -1.06 to 0.10; P=0.1), CMT (WMD: -0.83; 95%CI: -15.15 to 13.49; P=0.91). No significant difference was found in the improvement of BCVA and adverse event (AE) in IVC group, compared with IVR group after treatment of loading dosage [the 1st month BCVA (WMD: 0.01; 95%CI: -0.26 to 0.27; P=0.96), the 3rd month BCVA (WMD: -0.04; 95%CI: -0.14 to 0.06; P=0.46); the 6th month BCVA (WMD: -0.24; 95%CI: -1.62 to 1.14; P=0.73)], AE (OR: 0.84; 95%CI: 0.38 to 1.84; P=0.66)]. A slight difference was found in the effectiveness rate (OR: 1.70; 95%CI: 0.97 to 2.96; P=0.06), There were statistically significant differences between IVC and IVR treatment in terms of CMT [1st month CMT (WMD: -19.88; 95%CI: -27.94 to -11.82; P<0.001), 3rd month CMT (WMD: -23.31; 95%CI: -43.30 to -3.33; P=0.02), 6th month CMT (WMD: -74.74; 95%CI: -106.22 to -43.26; P<0.001)]. CONCLUSION: Pooled evidence suggests that both IVC and IVR are effective in the therapy of diabetic macular edema and affirms that IVC presents superiority over IVR therapy in regard of CMT in patients with diabetic macular edema, but no statistically significant difference with regard to visual improvement. Relevant RCTs with longer-term follow-up are necessary to back up our conclusion.     

Combination of ranibizumab with photodynamic therapy vs ranibizumab monotherapy in the treatment of age-related macular degeneration:a systematic review and meta-analysis of randomized controlled trials

AIM:To compare the efficacy and safety of combination of ranibizumab with photodynamic therapy (PDT) vs ranibizumab monotherapy in the treatment of age-related macular degeneration (AMD).METHODS:The Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, Pubmed, and Embase were searched. There were no language or data restrictions in the search for trials. Only randomized controlled trials (RCTs) were included. Methodological quality of the literatures was evaluated according to the Jadad Score. RevMan 5.2.6 software was used to do the meta-analysis.RESULTS:Seven studies were included in our systematic review, among which four of them were included in quantitative analysis. The result shows that the ranibizumab monotherapy group had a better mean best corrected visual acuity (BCVA) change vs baseline at month 12 compared with that of the combination treatment group, and the statistical difference was significant (WMD, -2.61; 95% CI, -5.08 to -0.13; P=0.04). However, after the removal of one study, the difference between the two groups showed no significant difference (WMD, -2.29; 95% CI, -4.81 to 0.23; P=0.07). Meanwhile, no significant central retinal thickness (CRT) reduction was found in the combination treatment group and the ranibizumab monotherapy group at 12 months follow-up. Nevertheless, the combination group tended to have a greater reduction in CRT (WMD, -4.13μm; 95%CI, -25.88 to 17.63, P=0.71). The proportion of patients gaining more than 3 lines at month 12 in the ranibizumab group was higher than in the combination group and there was a significant difference (RR, 0.72; 95% CI, 0.54 to 0.95; P=0.02). Whereas there was no significant difference for the proportion of patients gaining more than 0 line at month 12 between the two groups (RR, 0.93; 95% CI, 0.76 to 1.15; P=0.52). The general tendency shows a reduction in ranibizumab retreatment number in the combination treatment group compared with the ranibizumab monotherapy group. As major adverse events, the differences in the number of eye pain, endophthalmitis, hypertension and arterial thromboembolic events were not significant between the two groups, and the incidence of serious adverse events in the two groups was very low.CONCLUSION:For the maintenance of vision, the comparison of the combination of ranibizumab with PDT vs ranibizumab monotherapy shows no apparent difference. Compared with the combination of ranibizumab and PDT, patients treated with ranibizumab monothearpy may gain more visual acuity (VA) improvement. The combination treatment group had a tendency to reduce the number of ranibizumab retreatment. Both the two treatment strategies were well tolerated.     

Efficiency and safety of laser photocoagulation with or without intravitreal ranibizumab for treatment of diabetic macular edema: a systematic review and Meta-analysis

AIM: To compare the therapeutic effect and safety of laser photocoagulation along with intravitreal ranibizumab (IVR) versus laser therapy in treatment of diabetic macular edema (DME). METHODS: Pertinent publications were identified through comprehensive searches of PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov to identify randomized clinical trials (RCTs) comparing IVR+laser to laser monotherapy in patients with DME. Therapeutic effect estimates were determined by weighted mean differences (WMD) of change from baseline in best corrected visual acuity (BCVA) and central retinal thickness (CRT) at 6, 12, or 24mo after initial treatment, and the risk ratios (RR) for the proportions of patients with at least 10 letters of improvement or reduction at 12mo. Data regarding major ocular and nonocular adverse events (AEs) were collected and analyzed. The Review Manager 5.3.5 was used. RESULTS: Six RCTs involving 2069 patients with DME were selected for this Meta-analysis. The results showed that IVR+laser significantly improved BCVA compared with laser at 6mo (WMD: 6.57; 95% CI: 4.37-8.77; P<0.00001), 12mo (WMD: 5.46; 95% CI: 4.35-6.58; P<0.00001), and 24mo (WMD: 3.42; 95% CI: 0.84-5.99; P=0.009) in patients with DME. IVR+laser was superior to laser in reducing CRT at 12mo from baseline with statistical significance (WMD: -63.46; 95% CI: -101.19 to -25.73; P=0.001). The pooled RR results showed that the proportions of patients with at least 10 letters of improvement or reduction were in favor of IVR+laser arms compared with laser (RR: 2.13; 95% CI: 1.77-2.57; P<0.00001 and RR: 0.37; 95% CI: 0.22-0.62; P=0.0002, respectively). As for AEs, the pooled results showed that a significantly higher proportion of patients suffering from conjunctival hemorrhage (study eye) and diabetic retinal edema (fellow eye) in IVR+laser group compared to laser group (RR: 3.29; 95% CI: 1.53-7.09; P=0.002 and RR: 3.02; 95% CI: 1.24-7.32; P=0.01, respectively). The incidence of other ocular and nonocular AEs considered in this Meta-analysis had no statistical difference between IVR+laser and laser alone. CONCLUSION: The results of our analysis show that IVR+laser has better availability in functional (improving BCVA) and anatomic (reducing CRT) outcomes than laser monotherapy for the treatment of DME. However, the patients who received the treatment of IVR+laser may get a higher risk of suffering from conjunctival hemorrhage (study eye) and diabetic retinal edema (fellow eye).     

Overflow phenomenon in serum lutein after supplementation: a systematic review supported with SNPs analyses

Lutein, a type of carotenoids, is found to delay the onset and progression of age-related macular degeneration (AMD). Several lutein supplementation studies showed that after an initial increase, lutein serum levels demonstrated a subsequent decrease despite continuous supplementation. In this systematic literature review, this obscure phenomenon was tried to be explained. The subsequent drop in lutein levels was postulated due to down-regulation of lutein receptors scavenger receptor class B type I (SR-BI) in the gastrointestinal tract, upregulation of lutein degrading enzyme β-carotene dioxygenase (BCDO2), or perhaps a combination of both. Some single nucleotides polymorphisms (SNPs) that could have influence on the occurrence of this phenomenon. To date, an exact scientific explanation for this phenomenon has not been established. Further research is needed to investigate this phenomenon in depth to reach an irrefutable explanation, giving that lutein is proven to be effective in delaying the onset and progression of AMD and its metabolism in the human body becomes of equal importance.     

Ranibizumab for treatment of choroidal neovascularization secondary to age-related macular degeneration

PURPOSE: To evaluate the short-term outcomes after intravitreal ranibizumab (Lucentis; Genentech, Inc., South San Francisco, CA) injection in patients with neovascular age-related macular degeneration. METHODS: A review of data for consecutive patients who received intravitreal ranibizumab injection was conducted. The main outcome measures were mean visual acuity and central macular thickness at 3 months compared with those at baseline. Response to ranibizumab therapy was evaluated with particular attention to prior treatment with bevacizumab (Avastin; Genentech, Inc.). RESULTS: Mean baseline visual acuity of 231 eyes of 231 patients was 20/152, and 189 patients (81.8%) had undergone prior treatment, with 153 (65.4%) having received intravitreal bevacizumab. Mean visual acuity at 3 months, available for 203 patients (88%), was 20/126 (P = 0.004). Mean visual acuity for 98 patients treated with bevacizumab within 3 months before ranibizumab injection was 20/100 at baseline and 20/98 at 3 months (P = 0.35). Mean baseline central macular thickness was 278 microm for all patients and improved to 211 microm at 3 months (P < 0.001). Macular thickness decrease was noted irrespective of previous bevacizumab therapy. CONCLUSION: Ranibizumab therapy was associated with significant improvements in mean visual acuity and central macular thickness for the group of all patients. Patients who had received bevacizumab treatment within 3 months before initiating ranibizumab treatment had stability of, but no improvement in, visual acuity.     

6-weekly bevacizumab versus 4-weekly ranibizumab for neovascular age-related macular degeneration: a 2-year outcome

AIM: To compare visual acuity and central macular thickness (CMT) changes in neovascular age related macular degeneration patients treated with either 6 weekly bevacizumab regimen or 4 weekly ranibizumab on an as required basis. METHODS: Patients made an informed choice between bevacizumab 1.25 mg or ranibizumab 0.5 mg. The selected treatment was administered in the first 3 visits. Bevacizumab patients were followed-up 6 weekly and ranibizumab 4 weekly. Retreatment criteria was based on the reduction of >5 letters in the best-corrected visual acuity (BCVA), the presence of retinal fluid on optical coherence tomography (OCT) or new retinal haemorrhage. RESULTS: Visual acuity at 2y bevacizumab patients gained 7.0 letters and ranibizumab 9.2 (P=0.31, 95% CI -6.4 to 2.0). At 2y 86% of bevacizumab and 94% ranibizumab patients had not lost 15 letters or more (P=0.13). Mean CMT decreased at 2y bevacizumab by 146 µm, ranibizumab 160 µm (P=0.72). Mean number of injections was at 2y bevacizumzb 11.9, ranibizumab 10.3 (P=0.023). CONCLUSION: Bevacizumab 6 weekly on an as required basis was not demonstrably non-inferior to ranibizumab 4 weekly pro re nata (prn) in terms of BCVA and change in CMT. In the bevacizumab group, one more injection was required in the second year compared to the ranibizumab group.