Intravitreal anti-vascular endothelial growth factors, panretinal photocoagulation and combined treatment for proliferative diabetic retinopathy: a systematic review and network meta-analysis

被引：26

作者：

Fallico, Matteo ^{[1
]}

Maugeri, Andrea ^{[2
]}

Lotery, Andrew ^{[3
]}

Longo, Antonio ^{[1
]}

Bonfiglio, Vincenza ^{[4
]}

Russo, Andrea ^{[1
]}

Avitabile, Teresio ^{[1
]}

Pulvirenti, Alfredo ^{[5
]}

Furino, Claudio ^{[6
]}

Cennamo, Gilda ^{[7
]}

Barchitta, Martina ^{[2
]}

Agodi, Antonella ^{[2
]}

Reibaldi, Michele ^{[8
]}

机构：

[1] Univ Catania, Dept Ophthalmol, Catania, Italy

[2] Univ Catania, Dept Med & Surg Sci & Adv Technol GF Ingrassia, Catania, Italy

[3] Univ Southampton, Fac Med, Southampton, Hants, England

[4] Univ Palermo, Ophthalmol Sect, Dept Expt Biomed & Clin Neurosci, Palermo, Italy

[5] Univ Catania, Dept Clin & Expt Med, Catania, Italy

[6] Univ Bari, Dept Ophthalmol, Bari, Italy

[7] Univ Naples Federico II, Dept Publ Hlth, Naples, Italy

[8] Univ Turin, Dept Surg Sci, Eye Clin Sect, Turin, Italy

来源：

ACTA OPHTHALMOLOGICA | 2021年 / 99卷 / 06期

关键词：

aflibercept; bevacizumab; intravitreal anti‐ VEGF; panretinal photocoagulation; pegaptanib; proliferative diabetic retinopathy; ranibizumab; SCANNING LASER; FACTOR THERAPY; RANIBIZUMAB;

D O I：

10.1111/aos.14681

中图分类号：

R77 [眼科学];

学科分类号：

100212 ;

摘要：

Purpose To conduct a systematic review with network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing panretinal photocoagulation (PRP) versus anti-vascular endothelial growth factor (VEGF) treatment alone or in combination with PRP, for proliferative diabetic retinopathy (PDR). Methods PubMed, Medline and Embase databases were searched for RCTs comparing PRP versus intravitreal anti-VEGF therapy and/or combined PRP and intravitreal anti-VEGF for PDR. The primary outcome measures were the mean best corrected visual acuity (BCVA) change and the regression of neovascularization. Mean change of central macular thickness (CMT), the subgroup analyses of patients without diabetic macular oedema (DME) and the rate of vitreous haemorrhage and vitrectomy were secondary outcomes. Frequentist NMAs were performed. Results Twelve RCTs were included. For the 12-month mean BCVA change, NMA showed a better visual outcome in both the anti-VEGF group and combined group compared to PRP [anti-VEGF vs PRP, mean difference (MD) = 3.42; standard error (SE) = 1.5; combined vs PRP, MD = 3.92; SE = 1.65], with no difference between combined group and anti-VEGF (MD = -0.50; SE = 1.87). No difference in neovascularization regression was found between PRP and anti-VEGF alone or in combination with PRP, but there was significant inconsistency (p = 0.016). Subgroup analyses in patients without DME yielded no difference for the 12-month visual outcome between the three interventions, but with significant inconsistency (p = 0.005). Conclusion This NMA showed limited evidence of comparable efficacy in terms of neovascularization regression between PRP and anti-VEGF therapy alone or in combination with PRP, but better visual outcomes were associated with anti-VEGF use. Intravitreal anti-VEGF therapy could be a valid therapeutic option in association with PRP.

引用

页码：E795 / E805

页数：11