Intravitreal anti-vascular endothelial growth factor versus panretinal LASER photocoagulation for proliferative diabetic retinopathy: a systematic review and meta-analysis
| Autor: | Zaid Mammo, Matthew P. Simunovic, William B Yates |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Vascular Endothelial Growth Factor A
medicine.medical_specialty Visual acuity Adolescent medicine.medical_treatment Visual Acuity Angiogenesis Inhibitors Vitrectomy law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Ranibizumab Ophthalmology Diabetes Mellitus medicine Humans Anti vegf Diabetic Retinopathy Laser Coagulation business.industry Lasers Absolute risk reduction General Medicine Diabetic retinopathy medicine.disease Meta-analysis Vitreous hemorrhage 030221 ophthalmology & optometry medicine.symptom business |
| Zdroj: | Canadian Journal of Ophthalmology. 56:355-363 |
| ISSN: | 0008-4182 |
| DOI: | 10.1016/j.jcjo.2021.01.017 |
| Popis: | To systematically review and perform a meta-analysis on the available evidence for anti-vascular endothelial growth factor (anti-VEGF) monotherapy versus panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR).Systematic review and meta-analysis PARTICIPANTS: Randomized clinical trials included participants ≥18 years old with clinical or angiographic evidence of PDR. Interventions included were anti-VEGF monotherapy and PRP. Excluded studies were those with potentially biased treatment allocation and those offering combination therapies.The primary outcome was mean change in best-corrected visual acuity. Secondary outcomes were the proportion of patients developing severe (6/60) or moderate (6/24-6/60) vision loss, rates of vitrectomy or vitreous hemorrhage, worsening macula edema, and reduced visual field indices.Five studies of varying quality met the inclusion criteria (n = 632). The anti-VEGF intervention arm had a mean difference of -0.08 logMAR or 4 Early Treatment Diabetic Retinopathy Study (EDTRS) letters gained (p = 0.02) when compared with PRP at 12 months. The difference in rates of vitrectomy and vitreous hemorrhage favoured anti-VEGF over PRP (risk difference [RD] -0.10, p = 0.001 and RD -0.10, p = 0.003 respectively).This meta-analysis of the available evidence in patients with early PDR demonstrates a potential benefit for anti-VEGF over PRP alone. However, these benefits must be weighed against the relative costs of treatment and the potential risks of loss to follow-up. |
| Databáze: | OpenAIRE |
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