Takaisin Tulosta

Anti-VEGF for macular oedema secondary to central retinal vein occlusion

Evidence summaries
5.6.2014
Editors

Level of evidence: A

Compared to no treatment, repeated intravitreal injection of anti-VEGF agents in eyes with central retinal vein occlusion macular oedema improves visual outcomes at 6 months.

Summary

A Cochrane review «Anti‐vascular endothelial growth factor for macular oedema secondary to central retinal vein occlusion»1 «Braithwaite T, Nanji AA, Lindsley K et al. Anti-vascular endothelial growth factor for macular oedema secondary to central retinal vein occlusion. Cochrane Database Syst Rev 2014;(5):CD007325. »1 included 6 studies with a total of 937 subjects comparing outcomes at 6 months to sham injection for 4 anti-vascular endothelial growth factor (anti-VEGF) agents: aflibercept (VEGF Trap-Eye, Eylea), bevacizumab (Avastin), pegaptanib sodium (Macugen) and ranibizumab (Lucentis). Treatment with anti-VEGF agents increased the chance of a significant gain in vision at 6 months compared to sham injections. One study demonstrated sustained benefit at 12 months. The risk of losing significant vision was reduced by 80% in those receiving anti-VEGF therapy compared to those receiving sham treatment. Participants receiving anti-VEGF treatment had a greater reduction in mean central retinal thickness from baseline to 6 months than patients receiving sham, indicating enhanced resolution of macular oedema (table «Anti-VEGF compared with sham injection for central retinal vein occlusion macular oedema»1). No significant safety concerns were identified at 6 or 12 months, but the available studies did not allow a conclusion about their long-term effectiveness and safety to be drawn.

Table 1. Anti-VEGF compared with sham injection for central retinal vein occlusion macular oedema
Outcome Relative effect (95% CI) Assumed risk – Sham injection Corresponding risk - Anti-VEGF injection (95% CI) Participants (studies)
BCVA = best-corrected visual acuity
BCVA gain of 15 letters or more RR 2.71 (2.10 to 3.49) 182 per 1000 493 per 1000 (382 to 635) 937 (6 studies)
BCVA loss of 15 letters or more RR 0.20 (0.12 to 0.34) 219 per 1000 44 per 1000 (26 to 74) 766 (5 studies)
Mean change from baseline in central retinal thickness MD -267.4 µm (211.4 to 323.4) 481 (3 studies)

References

  1. Braithwaite T, Nanji AA, Lindsley K et al. Anti-vascular endothelial growth factor for macular oedema secondary to central retinal vein occlusion. Cochrane Database Syst Rev 2014;(5):CD007325. «PMID: 24788977»PubMed