两种不同方式治疗视网膜分支静脉阻塞继发黄斑水肿的meta分析

A meta-analysis of two different treatments for branch retinal vein occlusion with secondary macular edema

摘要:

目的 系统评价激光联合玻璃体腔注射雷珠单抗与单独玻璃体腔注射雷珠单抗治疗视网膜分支静脉阻塞(BRVO)继发黄斑水肿的疗效及安全性。方法 通过检索PubMed、CNKI、万方等数据库收集有关治疗BRVO继发黄斑水肿的随机对照试验研究(RCT)。检索时间为建库至2019年5月。采用RevMan 5.3软件对纳入文献进行meta分析。结果 共纳入12篇文献,包括1081例患者。meta分析结果显示:与单纯注药组相比,联合治疗组黄斑中心凹厚度(CMT)在随访1、3、6个月时均降低,差异有统计学意义[95%CI(-135.44~-15.54),P<0.001]；但对于最佳矫正视力(BCVA)的提高,2组间无统计学差异[95%CI(-1.75~0.80),P>0.05]；2组不良反应的发生率无统计学差异[OR=1.50,95%CI(0.97~2.30),P=0.07]。结论 激光联合玻璃体腔注射雷珠单抗能够显著降低BRVO继发黄斑水肿患者的CMT,早期疗效优于单纯注药组。但两种方式对于治疗后BCVA的影响及不良反应的发生尚需要大样本的随机对照双盲研究加以验证。

Abstract:

Objective To systematically evaluate the differences in efficacy and safety between laser combined with intravitreal ranibizumab and intravitreal ranibizumab alone in the treatment of branch retinal vein occlusion (BRVO) with secondary macular edema. Methods Data was collected about randomized controlled trial for the treatment of BRVO with secondary macular edema via a search conducted in PubMed, CNKI, Wanfang and other databases, time being set from their establishment to May 2019. A meta-analysis was performed of the included studies using RevMan 5.3 statistics. Results A total of 12 studies were included with 1081 patients. Compared with intravitreal ranibizumab alone, the combination of laser with intravitreal ranibizumab was able to effectively reduce the central macular retinal thickness (CMT) [95%CI(-135.44--15.54), P<0.001] on the followed-up visits at 1,3 and 6 months; but there was no statistically significant difference in the improvement of best corrected visual acuity (BCVA) [95%CI (-1.75-0.80), P>0.05] and in the incidence of adverse reactions between the two groups [OR=1.50,95%CI (0.97-2.30), P=0.07]. Conclusion Laser combined with intravitreal ranibizumab can significantly reduce the CMT in BRVO patients with secondary macular edema, with better early efficacy than intravitreal ranibizumab alone. However, the effects of the two methods on BCVA after treatment and the occurrence of adverse reactions is yet to be verified by a large number of randomized double-blind controlled studies.