抗VEGF药物联合皮质类固醇激素治疗视网膜静脉阻塞性黄斑水肿的Meta分析

目的:评价抗VEGF药物联合糖皮质类固醇激素治疗视网膜静脉阻塞性黄斑水肿的临床效果。方法:计算机全面检索PubMed、Embase、The Cochrane Library、中国知网、万方、维普数据库6个数据库,检索时间从建库至2020-01,收集抗VEGF药物联合皮质类固醇激素治疗视网膜静脉阻塞性黄斑水肿的随机对照试验(RCT)。由2名研究人员根据纳入和排除标准,独立检索文献、提取数据及进行方法学质量评估,采用Review Manager 5.3进行Meta分析。结果:最终纳入5篇RCT文献,共212例患者。Meta分析结果显示,在第1、3、6mo,抗VEGF药物联合皮质类固醇药物与单用抗VEGF药物对提高患者最佳矫正视力(BCVA)无差异;在缓解黄斑水肿方面,在第1mo和第3mo联合用药的治疗效果要高于单用抗VEGF药物,差异具有统计学意义(1mo:MD=-20.89,95%CI:-34.65~-7.13,P=0.003;3mo:MD=-22.83,95%CI:-33.68~-11.97,P<0.0001),在第6mo两组无差异(P=0.06);联合用药的不良反应及并发症发生率高于单用抗VEGF药物(P=0.02);联合用药注射次数要低于单用抗VEGF药物(P<0.001)。结论:相比较单一使用抗VEGF药物,抗VEGF药物联合皮质类固醇激素治疗视网膜静脉阻塞性黄斑水肿具有起效快、注射次数少、更加经济的特点,但不良反应及并发症的发生率高于单一用药,主要为眼压升高及白内障,治疗过程要严密随访患者眼压及晶状体情况。

Meta-analysis of anti-VEGF drugs combined steroids for macular edema secondary to retinal vein occlusion

AIM: To evaluate the clinical effects of using anti-VEGF drugs combined with Steroids to treat macular edema(ME)secondary to retinal vein occlusion.

METHODS: Chinese and English electronic databases(Pubmed, Embase, Cochrane, CNKI, Wanfang and Weipu)were searched to obtain qualified random controlled test(RCT)researches from their foundation to January 2020. According to inclusion and exclusion criteria, two researchers retrieved the literature independently, extracted data and evaluate methodological quality. Review Manager 5.3 was used for Meta-analysis.

RESULTS: A total of 5 RCTs were identified with 212 patients. There was no significant difference in patients'' best correct visual acuity(BCVA)improvement in 1mo, 3mo and 6mo between anti-VEGF combined with steroids and anti-VEGF monopoly. Significant difference was found in the relieve of ME in 1mo and 3mo(1mo: MD=-20.89, 95% CI: -34.65 to -7.13, P=0.003; 3mo: MD=-22.83, 95% CI: -33.68 to -11.97, P<0.0001), but not in 6mo between two groups. As for side effects and complications, the combination group occurs more often than the monopoly group(P=0.02). Meanwhile, significant difference was found in the number of injections between two groups(P<0.001).

CONCLUSION: Compared with the single use of anti-VEGF drugs, anti-VEGF drugs combined with corticosteroids for the treatment of ME secondary to RVO have the characteristics of rapid onset, fewer injections, and more economical. The treatment process should closely follow the patient''s intraocular pressure and lens status.