Comparative Efficacy of Endovascular Therapy and Microsurgery in Treating Ophthalmic Artery Aneurysms: A Systematic Review and Meta-Analysis

Background Ophthalmic artery (OphA) aneurysms, occurring at the junction of the internal carotid artery and the OphA orifice, present significant treatment challenges due to their location and complex anatomy. This systematic review and meta-analysis aimed to evaluate endovascular therapy and microsurgery in managing OphA aneurysms. Methods Adhering to Cochrane Handbook guidelines, a comprehensive search was conducted in ClinicalTrials.gov and 4 databases (PubMed, Scopus, Web of Science, and Embase). Study quality was assessed using the National Institutes of Health tool. Statistical analyses were performed with Review Manager and open MetaAnalyst software. Results The meta-analysis included 9 articles, covering 902 OphA aneurysms. Cohort studies showed fair quality, while case series demonstrated good quality. No significant difference in clinical outcomes was found between endovascular therapy and surgery. Post-treatment visual outcomes had an odds ratio (OR) of 2.48 (95% confidence interval [CI] [0.35, 17.45], P = 0.36), modified Rankin Scale (mRS) >2 outcomes had an OR of 0.53 (95% CI [0.16, 1.7], P = 0.28), and severe complications had an OR of 0.52 (95% CI [0.20, 1.35], P = 0.18). In the single-arm analysis, direct surgery outcomes for visual, mRS >2, severe complications, intraoperative aneurysm rupture, and postoperative infarction were 0.139, 0.008, 0.05, 0.036, and 0.037, respectively. In the endovascular group, these outcomes were 0.078, 0.028, 0.03, and 0.691, respectively. Conclusions Our comparison of endovascular therapy and surgery for OphA aneurysms showed no significant difference in clinical outcomes. However, visual complications were more common with surgery, while mRS >2 was higher with endovascular therapy. Flow diversion reduced visual deficits compared to clipping and coiling, but further studies are needed.