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. 2013 Oct 25;8(10):e78538.
doi: 10.1371/journal.pone.0078538. eCollection 2013.

Efficacy and safety of intravitreal therapy in macular edema due to branch and central retinal vein occlusion: a systematic review

Amelie Pielen  1 , Nicolas Feltgen, Christin Isserstedt, Josep Callizo, Bernd Junker, Christine Schmucker
Affiliations

Efficacy and safety of intravitreal therapy in macular edema due to branch and central retinal vein occlusion: a systematic review

Amelie Pielen et al. PLoS One. .

Abstract

Background: Intravitreal agents have replaced observation in macular edema in central (CRVO) and grid laser photocoagulation in branch retinal vein occlusion (BRVO). We conducted a systematic review to evaluate efficacy and safety outcomes of intravitreal therapies for macular edema in CRVO and BRVO.

Methods and findings: MEDLINE, Embase, and the Cochrane Library were systematically searched for RCTs with no limitations of language and year of publication. 11 RCTs investigating anti-VEGF agents (ranibizumab, bevacizumab, aflibercept) and steroids (triamcinolone, dexamethasone implant) with a minimum follow-up of 1 year were evaluated.

Efficacy crvo: Greatest gain in visual acuity after 12 months was observed both under aflibercept 2 mg: +16.2 letters (8.5 injections), and under bevacizumab 1.25 mg: +16.1 letters (8 injections). Ranibizumab 0.5 mg improved vision by +13.9 letters (8.8 injections). Triamcinolone 1 mg and 4 mg stabilized visual acuity at a lower injection frequency (-1.2 letters, 2 injections).

Brvo: Ranibizumab 0.5 mg resulted in a visual acuity gain of +18.3 letters (8.4 injections). The effect of dexamethasone implant was transient after 1.9 implants in both indications.

Safety: Serious ocular adverse events were rare, e.g., endophthalmitis occurred in 0.0-0.9%. Major differences were found in an indirect comparison between steroids and anti-VEGF agents for cataract progression (19.8-35.0% vs. 0.9-7.0%) and in required treatment of increased intraocular pressure (7.0-41.0% vs. none). No major differences were identified in systemic adverse events.

Conclusions: Anti-VEGF agents result in a promising gain of visual acuity, but require a high injection frequency. Dexamethasone implant might be an alternative, but comparison is impaired as the effect is temporary and it has not yet been tested in PRN regimen. The ocular risk profile seems to be favorable for anti-VEGF agents in comparison to steroids. Because comparative data from head-to-head trials are missing currently, clinicians and patients should carefully weigh the benefit-harm ratio.

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Conflict of interest statement

Competing Interests: The authors have the following interests. Amelie Pielen is consultant for Allergan, Bayer HealthCare and Novartis Pharma, investigator in multicenter clinical trials sponsored by Bayer HealthCare, Novartis Pharma, GlaxoSmithKline, Pfizer, Alcon, Accovion and Genentech, received research grants from Novartis Pharma and travel grants from Bayer HealthCare. Nicolas Feltgen is consultant for Bayer, Novartis and Allergan, investigator in clinical trials sponsored by Bayer, Novartis and Allergan and received research and travel grants from Novartis. Josep Callizo is consultant for Bayer, Allergan and Novartis, investigator in clinical trials sponsored by Bayer, Allergan and Novartis and received travel grant from Novartis. Bernd Junker is investigator in multicenter clinical trials sponsored by Bayer HealthCare, Novartis Pharma, GlaxoSmithKline, Pfizer, Alcon, Accovion and Genentech and functioned as lecturer for Heidelberg Engeneering, Allergan and Novartis. This does not alter their adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Flow chart of literature search and study selection.
Figure 2
Figure 2. Bar graph for results in central retinal vein occlusion (CRVO).
Change in best corrected visual acuity (BCVA) in letters at month 12 for each treatment group (left) and percentage of patients with gain of BCVA of equal or more than 15 letters (right).
Figure 3
Figure 3. Bar graph for results in branch retinal vein occlusion
(BRVO). Change in best corrected visual acuity (BCVA) in letters at month 12 for each treatment group (left) and percentage of patients with gain of BCVA of equal or more than 15 letters (right); SGLT: subthreshold grid laser photocoagulation.
See this image and copyright information in PMC

References

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