Anti-vascular endothelial growth factor treatment compared with steroid treatment for retinal vein occlusion: a meta-analysis

Background: This meta-analysis aims to compare the efficacy and safety of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents and intravitreal steroids for the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO)however, a continual reevaluation of their comparative efficacy is required. Objectives: This meta-analysis aims to compare the efficacy and safety of intravitreal anti-VEGF agents and intravitreal steroids for the treatment of ME secondary to RVO. Methods: A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and the Cochrane Controlled Register of Trials for studies published between January 2005 and November 2021. Randomized controlled trials (RCTs) reporting on patients with ME secondary to RVO who were treated with intravitreal steroids or anti-VEGF agents were included. A random effects meta-analysis was performed. Results: 867 eyes from 11 RCTs were included. At last study observation, intravitreal anti-VEGF agents were associated with a significantly better BCVA (WMD=-0.14 logMAR, 95% CI=[-0.19,-0.09], p < 0.00001) and lower retinal thickness (WMD=-38.01 mu m, 95% CI=[-56.17,-19.85], p < 0.0001) relative to intravitreal steroids. Similar findings were found at 3-12 month timepoints. Intravitreal anti-VEGF agents were associated with a significantly lower incidence of IOP-related adverse events (RR=0.28, 95% CI=[0.15,0.51], p < 0.0001), cataract development/progression (RR=0.22, 95% CI=[0.09,0.49], p=0.0003) and conjunctival hemorrhage (RR=0.52, 95% CI=[0.32,0.86], p=0.01). Conclusion: Our meta-analysis found superiority of intravitreal anti-VEGF agents relative to intravitreal steroids for the treatment of ME secondary to RVO with regards to visual acuity, anatomic outcomes, and safety endpoints.