摘要
目的评价玻璃体腔注射抗血管内皮生长因子(VEGF)药物联合视网膜激光光凝与单纯抗VEGF药物治疗视网膜静脉阻塞(RVO)合并黄斑水肿(ME)的疗效。方法循证医学研究。分别以视网膜静脉闭(阻)塞、黄斑水肿、抗血管内皮生长因子、贝伐单抗、雷珠单抗、康柏西普、阿柏西普、视网膜激光光凝为中英文检索词,在中国知网、万方、维普、美国国立医学图书馆PubMed和在线数据库Medline、荷兰医学文摘Embase、Cochrane图书馆检索相关文献。选取以RVO合并ME作为研究对象,治疗方案采用玻璃体腔注射抗VEGF药物联合激光光凝和单纯抗VEGF药物治疗相比较的临床随机对照研究。检索时间2011年1月至2021年2月。排除重复、信息不完整或不相关文献以及病例报告和综述性文献。采用Review Manager 5.4统计软件对文献进行meta分析。选择加权均数差(WMD)和95%可信区间(CI)作为效应量的估计值,并用固定效应模型进行分析。评价指标为最佳矫正视力(BCVA)、黄斑中心凹厚度(CMT)、注射次数。结果根据检索策略初步检索出461篇文献,最终纳入21篇文献进行meta分析。共纳入患者1156例,其中抗VEGF药物联合激光光凝治疗(联合治疗组)576例,单纯抗VEGF药物治疗(单纯药物治疗组)580例。Meta分析结果显示,治疗后6、9、12个月,单纯药物治疗组、联合治疗组患者BCVA、CMT比较,差异均无统计学意义(BCVA:WMD=-0.82,95%CI -2.38~ 0.74,P=0.30;CMT:WMD=-3.12,95%CI -17.25 ~11.01 ,P=0.67 )。对于视网膜分支静脉阻塞合并ME者,联合治疗较单纯药物治疗能更有效地降低注射次数(WMD=-0.80,95%CI-1.18~-0.42,Z=4.10,P<0.000 1 )。结论与单纯玻璃体腔注射抗VEGF药物治疗比较,联合视网膜激光光凝治疗不能更好改善RVO合并ME患者BCVA和CMT;而对于视网膜分支静脉阻塞合并ME患者,联合视网膜激光光凝治疗能有效减少抗VEGF药物注射次数。
Objective To evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs combined with retinal laser photocoagulation and anti-VEGF drugs alone in the treatment of retinal vein occlusion(RVO)combined with macular edema(ME).Methods A evidence-based medicine study.Retinal vein occlusion(obstruction),macular edema,anti-vascular endothelial growth factor,bevacizumab,ranibizumab,conbercept,aflibercept,and retinal laser photocoagulation were the Chinese and English search terms.Related literature was searched in China National Knowledge Infrastructure,Wanfang,Weipu,PubMed,Embase,Cochrane Library.RVO combined with ME was selected as the research object,and the treatment plan was a clinical randomized controlled study comparing intravitreal injection of anti-VEGF drugs combined with laser photocoagulation and anti-VEGF drugs alone.The search time range was from January 2011 to February 2021.Repeated,incomplete or irrelevant literature,case reports and review literature were excluded.Review Manager 5.4 statistical software was used to conduct a meta-analysis of the literature.The weighted mean difference(WMD)and 95%confidence interval(Cl)were selected as the estimated value of effect size,and the fixed effect model was used for analysis.The evaluation indicators were best corrected visual acuity(BCVA),center macular thickness(CMT),and the number of injections.Results According to the search strategy,461 articles were initially retrieved,and 21 articles were finally included for meta-analysis.A total of 1156 patients were enrolled,of which 576 were treated with anti-VEGF drugs combined with laser photocoagulation(combined treatment group),and 580 were treated with anti-VEGF drugs alone(drug treatment group).Meta-analysis results showed that there was no statistically significant difference in BCVA and CMT between the drug treatment group and the combination treatment group at 6,9,and 12 months after treatment(BCVA:WMD=-0.82,95%CI-2.38-0.74,P=0.30;CMT:WMD=-3.12,95%CI-17.25-11.01,P=0.61).For patients with branch retinal vein occlusion and ME,combined therapy can reduce the number of injections more effectively than drug therapy alone(WMD=-0.80,95%CI-1.18-0.42,Z=4.10,P<0.0001).Conclusion Compared with pure intravitreal injection of anti-VEGF drugs,combined retinal laser photocoagulation can not better improve BCVA and CMT in patients with RVO and ME.For patients with branch retinal vein occlusion and ME,combined retinal laser photocoagulation can effectively reduce the resistance.The number of VEGF injections.
作者
黄江
邹维杰
季晓燕
华伍梅
徐森
杜媛媛
周忱
徐国旭
张积
Huang Jiang;Zou Weijie;Ji Xiaoyan;Hua Wumei;Xu Sen;Du Yuanyuan;Zhou Chen;Xu Guoxu;Zhang Ji(Department of Ophthalmology,The Second Affiliated Hospital ofSoochow University,Suzhou 215004,China;State Key Laboratory of Radiation Medicine and Protection,Soochow University,Suzhou 215123,China)
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2021年第9期715-722,共8页
Chinese Journal of Ocular Fundus Diseases
基金
放射医学与辐射防护国家重点实验室资助项目(GZK1202141)
江苏省中医药科技发展计划项目(YB2020060)
苏州大学附属第二医院博士、留学归国人员预研项目(SDFEYBS1903)。
