目的:比较玻璃体内阿柏西普与地塞米松植入治疗糖尿病性视网膜病变(DR)或视网膜静脉阻塞(RVO)相关黄斑水肿(ME)的疗效和安全性。
方法:在PubMed,Embase,和Cochrane中央受控试验登记册,从图书馆开始到2021年4月16日。提取包括最佳矫正视力(BCVA)在内的数据,中央视网膜厚度(CRT),最终合格文章的注射次数和严重不良事件(SAE)。采用RevMan5.3软件对纳入研究进行Meta分析。
结果:共纳入7项369眼的研究。最终筛查研究中ME的病因包括RVO和DR。与阿柏西普治疗组相比,地塞米松植入治疗组的BCVA在3mo[均差(MD):-0.05,95%置信区间(CI):-0.11,0.02;P=0.17]和12mo(MD:-0.01,95CI:-0.38,0.37;P=0.98)的随访中没有显着差异,但在6mo时比阿柏西普组稍差(MD:0.12,95CI:0.03,0.21;P=0.008).就减少CRT而言,3mo时两组间无显著性差异(MD:-28.14,95CI:-79.95,23.67;P=0.29),6mo(MD:27.67,95CI:-84.89,140.24;P=0.63),和12mo(MD:-59.00,95CI:-127.37,9.37;P=0.09)。然而,地塞米松植入物注射次数较少,但更多的不良事件,如眼内压(IOP)升高和白内障。
结论:玻璃体内注射阿柏西普和地塞米松均可有效增加BCVA和降低CRT。与aflibercept相比,在初始治疗期(3mo)和长期治疗期(12mo),地塞米松植入物在改善视力和减少CRT方面并不逊色。此外,注射次数较少,更容易引起IOP升高和白内障.
OBJECTIVE: To compare the efficacy and safety of intravitreal aflibercept with dexamethasone implant in the treatment of macular edema (ME) associated with diabetic retinopathy (DR) or retinal vein occlusion (RVO).
METHODS: A comprehensive search of studies comparing dexamethasone and aflibercept in patients with ME was conducted at PubMed, Embase, and Cochrane Central Register of Controlled Trials from the beginning of library to April 16, 2021. Extracting the data including best-corrected visual acuity (BCVA), central retinal thickness (CRT), number of injections and serious adverse events (SAEs) from the final qualified articles. RevMan 5.3 software was used for Meta-analysis of the included studies.
RESULTS: Totally 7 studies with 369 eyes were included. The causes of ME in the final screening study included RVO and DR. Compared with the aflibercept treatment group, the BCVA of the dexamethasone implant treatment group showed no significant difference in the follow-up for 3mo [mean difference (MD): -0.05, 95% confidence interval (CI): -0.11, 0.02; P=0.17] and 12mo (MD: -0.01, 95%CI: -0.38, 0.37; P=0.98), but it was slightly worse than the aflibercept group at 6mo (MD: 0.12, 95%CI: 0.03, 0.21; P=0.008). In terms of CRT reduction, there was no significant difference between the two groups at 3mo (MD: -28.14, 95%CI: -79.95, 23.67; P=0.29), 6mo (MD: 27.67, 95%CI: -84.89, 140.24; P=0.63), and 12mo (MD: -59.00, 95%CI: -127.37, 9.37; P=0.09). However, dexamethasone implant had fewer injections, but more adverse events such as elevated intraocular pressure (IOP) and cataract.
CONCLUSIONS: Intravitreal injection of aflibercept and dexamethasone implant can both effectively increase BCVA and reduce CRT. Compared with aflibercept, dexamethasone implant is not inferior in improving vision and reducing CRT in the initial treatment period (3mo) and long-term treatment period (12mo). Besides, it has fewer injections and more likely to cause elevated IOP and cataract.