Intravitreal Dexamethasone Implants versus Intravitreal Anti-VEGF Treatment in Treating Patients with Retinal Vein Occlusion: A Meta-analysis

Abstract Background: Retinal vein occlusion (RVO) is a common retinal venous disorder that causes vision loss. No specific therapy has been developed. Controversy exists regarding two treatments: intravitreal dexamethasone implants and anti-vascular endothelial growth factor (VEGF). The goal of this study is to compare the effectiveness and safety of dexamethasone implants and anti-VEGF treatment for RVO. Methods: The PubMed, Embase, and Cochrane Library databases were searched for studies comparing dexamethasone implants with anti-VEGF in patients with RVO. Best-corrected visual acuity (BCVA), central subfield thickness (CST), intraocular pressure changes, conjunctival haemorrhage, reduced VA, and macular oedema were extracted from the final included studies. RevMan 5.3 was used to conduct the quantitative analysis and bias assessment. Results: Four articles assessing 969 eyes were included. The anti-VEGF treatment showed better BCVA improvement (mean difference [MD] = -10.59, P < 0.00001) and more CST decrease (MD = -86.71 μm, P = 0.02) than the dexamethasone implants. However, the dexamethasone implants required fewer injections. As for adverse effects, the dexamethasone implants showed significantly higher intraocular pressure (IOP) and more cataracts than the anti-VEGF treatment. No significant differences were found in conjunctival haemorrhage, reduced VA, and macular oedema. Conclusions: Anti-VEGF treatment showed better functional and anatomical improvement with less risk of IOP elevation and cataract formation compared to dexamethasone implants. Thus, anti-VEGF treatment is the first choice for treating RVO patients. Keywords: dexamethasone intravitreal implant, anti-VEGF treatment, retinal vein occlusion, meta-analysis

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Intravitreal Dexamethasone Implants versus Intravitreal Anti-VEGF Treatment in Treating Patients with Retinal Vein Occlusion: A Meta-analysis

10.21203/rs.1.7/v2 ◽

2018 ◽

Author(s):

Qian Shi ◽

Lixiong Gao ◽

Lijun Zhou ◽

Chunyu Tian ◽

Na Li ◽

...

Keyword(s):

Intraocular Pressure ◽

Retinal Vein Occlusion ◽

Macular Oedema ◽

Vision Loss ◽

Meta Analysis ◽

Cochrane Library ◽

Vein Occlusion ◽

Anti Vegf ◽

First Choice ◽

Intravitreal Dexamethasone

Abstract Background: Retinal vein occlusion (RVO) is a common retinal venous disorder that causes vision loss. No specific therapy has been developed. Controversy exists regarding two treatments: intravitreal dexamethasone implants and anti-vascular endothelial growth factor (VEGF). The goal of this study is to compare the effectiveness and safety of dexamethasone implants and anti-VEGF treatment for RVO. Methods: The PubMed, Embase, and Cochrane Library databases were searched for studies comparing dexamethasone implants with anti-VEGF in patients with RVO. Best-corrected visual acuity (BCVA), central subfield thickness (CST), intraocular pressure changes, conjunctival haemorrhage, reduced VA, and macular oedema were extracted from the final included studies. RevMan 5.3 was used to conduct the quantitative analysis and bias assessment. Results: Four articles assessing 969 eyes were included. The anti-VEGF treatment showed better BCVA improvement (mean difference [MD] = -10.59, P < 0.00001) and more CST decrease (MD = -86.71 μm, P = 0.02) than the dexamethasone implants. However, the dexamethasone implants required fewer injections. As for adverse effects, the dexamethasone implants showed significantly higher intraocular pressure (IOP) and more cataracts than the anti-VEGF treatment. No significant differences were found in conjunctival haemorrhage, reduced VA, and macular oedema. Conclusions: Anti-VEGF treatment showed better functional and anatomical improvement with less risk of IOP elevation and cataract formation compared to dexamethasone implants. Thus, anti-VEGF treatment is the first choice for treating RVO patients. Keywords: dexamethasone intravitreal implant, anti-VEGF treatment, retinal vein occlusion, meta-analysis

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Intravitreal Dexamethasone Implants versus Intravitreal Anti-VEGF Treatment in Treating Patients with Retinal Vein Occlusion: A Meta-analysis

10.21203/rs.1.7/v4 ◽

2019 ◽

Author(s):

Qian Shi ◽

Lixiong Gao ◽

Lijun Zhou ◽

Chunyu Tian ◽

Na Li ◽

...

Keyword(s):

Intraocular Pressure ◽

Retinal Vein Occlusion ◽

Macular Oedema ◽

Vision Loss ◽

Meta Analysis ◽

Cochrane Library ◽

Vein Occlusion ◽

Anti Vegf ◽

First Choice ◽

Intravitreal Dexamethasone

Abstract Background: Retinal vein occlusion (RVO) is a common retinal venous disorder that causes vision loss. No specific therapy has been developed. Controversy exists regarding two treatments: intravitreal dexamethasone implants and anti-vascular endothelial growth factor (VEGF). The goal of this study is to compare the effectiveness and safety of dexamethasone implants and anti-VEGF treatment for RVO. Methods: The PubMed, Embase, and Cochrane Library databases were searched for studies comparing dexamethasone implants with anti-VEGF in patients with RVO. Best-corrected visual acuity (BCVA), central subfield thickness (CST), intraocular pressure changes, conjunctival haemorrhage, reduced VA, and macular oedema were extracted from the final included studies. RevMan 5.3 was used to conduct the quantitative analysis and bias assessment. Results: Four articles assessing 969 eyes were included. The anti-VEGF treatment showed better BCVA improvement (mean difference [MD] = -10.59, P < 0.00001) and more CST decrease (MD = -86.71 μm, P = 0.02) than the dexamethasone implants. However, the dexamethasone implants required fewer injections. As for adverse effects, the dexamethasone implants showed significantly higher intraocular pressure (IOP) and more cataracts than the anti-VEGF treatment. No significant differences were found in conjunctival haemorrhage, reduced VA, and macular oedema. Conclusions: Anti-VEGF treatment showed better functional and anatomical improvement with less risk of IOP elevation and cataract formation compared to dexamethasone implants. Thus, anti-VEGF treatment is the first choice for treating RVO patients. Keywords: dexamethasone intravitreal implant, anti-VEGF treatment, retinal vein occlusion, meta-analysis

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Comparison of intravitreal dexamethasone implant and anti-VEGF drugs in the treatment of retinal vein occlusion-induced oedema: a meta-analysis and systematic review

BMJ Open ◽

10.1136/bmjopen-2019-032128 ◽

2020 ◽

Vol 10 (6) ◽

pp. e032128

Author(s):

Shuai Ming ◽

Kunpeng Xie ◽

Mingzhu Yang ◽

Huijuan He ◽

Ya Li ◽

...

Keyword(s):

Systematic Review ◽

Retinal Vein Occlusion ◽

Real World ◽

Meta Analysis ◽

Real Life ◽

Cochrane Library ◽

Efficacy And Safety ◽

Vein Occlusion ◽

Anti Vegf ◽

Intravitreal Dexamethasone

ObjectiveTo compare the efficacy and safety of intravitreal dexamethasone (DEX) implant and anti-vascular endothelial growth factor (anti-VEGF) agents in the treatment of macular oedema secondary to retinal vein occlusion (RVO).DesignSystematic review and meta-analysis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE).Data sourcesPubMed, Cochrane Library and ClinicalTrials.gov registry were searched from inception to 10 December 2019, without language restrictions.Eligibility criteriaRandomised controlled trials (RCTs) and real-world observation studies comparing the efficacy of DEX implant and anti-VEGF agents for the treatment of patients with RVO, naïve or almost naïve to both arms, were included.Data extraction and synthesisTwo reviewers independently extracted data for mean changes in best-corrected visual acuity (BCVA), central subfield thickness (CST) and product safety. Review Manager V.5.3 and GRADE were used to synthesise the data and validate the evidence, respectively.ResultsFour RCTs and 12 real-world studies were included. An average lower letter gain in BCVA was determined for the DEX implant (mean difference (MD) = −6.59; 95% CI −8.87 to −4.22 letters) administered at a retreatment interval of 5–6 months. Results were similar (MD6 months=−12.68; 95% CI −21.98 to −3.37 letters; MD12 months=−9.69; 95% CI −12.01 to −7.37 letters) at 6 and 12 months. The DEX implant resulted in comparable or marginally less CST reduction at months 6 and 12 but introduced relatively higher risks of elevated intraocular pressure (RR=3.89; 95% CI 2.16 to 7.03) and cataract induction (RR=5.22; 95% CI 1.67 to 16.29). Most real-life studies reported an insignificant numerical gain in letters for anti-VEGF drugs relative to that for DEX implant. However, the latter achieved comparable efficacy with a 4-month dosage interval.ConclusionCompared with anti-VEGF agents, DEX implant required fewer injections but had inferior functional efficacy and safety. Real-life trials supplemented the efficacy data for DEX implant.

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Ozurdex Treatment for Retinal Conditions: A Systematic Review and Meta-analysis

10.21203/rs.3.rs-1049836/v1 ◽

2021 ◽

Author(s):

Hui-xin Tang ◽

Yu-qin Yang ◽

Ying Yuan ◽

Jing-jing Li ◽

Zubing Mei ◽

...

Keyword(s):

Systematic Review ◽

Intraocular Pressure ◽

Macular Edema ◽

Retinal Vein Occlusion ◽

Clinical Efficacy ◽

Meta Analysis ◽

Cochrane Library ◽

Vein Occlusion ◽

Anti Vegf ◽

Elevated Intraocular Pressure

Abstract Objectives To evaluate the clinical efficacy of Ozurdex, a dexamethasone (DEX) implant, for the treatment of macular edema (ME) caused by retinal vein occlusion (RVO) and diabetic retinopathy (DR) through a systematic review and meta-analysis.Methods The PubMed, Embase and Cochrane Library databases were comprehensively searched from inception to July 11, 2021 for studies evaluating the clinical efficacy of Ozurdex for patients with retinal vein occlusion macular edema (RVO-ME) or diabetic macular edema (DME). Eligible studies were published in English and were randomized controlled trials (RCTs). The Cochrane Collaboration’s tool was applied to assess the risk of bias in each study. Effect estimates with 95% confidence intervals (CIs) were pooled using the random effects model. We also conducted subgroup analyses to explore sources of heterogeneity and the stability of the results.Results This meta-analysis included 7 RCTs (RVO-ME [n=2] and DME [n=5]) assessing a total of 251 eyes. Compared with anti-VEGF therapy, Ozurdex treatment achieved superior outcomes in terms of best corrected visual acuity (BCVA) (mean difference [MD] =-2.83 ([95% CI, -5.60 to -0.05], P=0.05), while no heterogeneity was found (P=0.49, I2=0%). Ozurdex treatment also significantly reduced central macular thickness (CMT) compared with anti-VEGF treatment (MD =-31.32 [95% CI, -57.92 to -4.72], P=0.02) and showed high between-trial heterogeneity (P=0.04, I2=54%). In terms of severe adverse events, Ozurdex treatment had a higher risk of elevated intraocular pressure than anti-VEGF therapy (RR=5.14; 95% CI: 1.42 to 18.66; P＜0.05), and there was no significant difference in cataract progression between the two groups (RR=1.83; 95% CI: 0.63 to 5.27, P=0.31).Conclusions Compared with anti-VEGF therapy, Ozurdex treatment is more effective in improving BCVA and reducing ME. Additionally, Ozurdex treatment has a higher risk of elevated intraocular pressure. Due to the small number of studies and the short follow-up period, the results should be interpreted with caution. The long-term effects of the two treatments need to be further determined.

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Intravitreal dexamethasone implants versus intravitreal anti-VEGF treatment in treating patients with retinal vein occlusion: a meta-analysis

BMC Ophthalmology ◽

10.1186/s12886-018-1016-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Lixiong Gao ◽

Lijun Zhou ◽

Chunyu Tian ◽

Na Li ◽

Weiyang Shao ◽

...

Keyword(s):

Retinal Vein Occlusion ◽

Meta Analysis ◽

Vein Occlusion ◽

Anti Vegf ◽

Intravitreal Dexamethasone

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Results of a Meta-Analysis on Intravitreal anti-VEGF Treatment of Macular Oedema Secondary to Branch Retinal Vein Occlusion (BRVO)

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/s-0042-123025 ◽

2017 ◽

Vol 234 (04) ◽

pp. 551-555 ◽

Cited By ~ 1

Author(s):

H. Gerding

Keyword(s):

Retinal Vein Occlusion ◽

Macular Oedema ◽

Branch Retinal Vein Occlusion ◽

Meta Analysis ◽

Vein Occlusion ◽

Anti Vegf

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Visual acuity outcomes and anti-VEGF therapy intensity in macular oedema due to retinal vein occlusion: a real-world analysis of 15 613 patient eyes

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317337 ◽

2020 ◽

pp. bjophthalmol-2020-317337

Author(s):

Thomas Ciulla ◽

John S Pollack ◽

David F Williams

Keyword(s):

Visual Acuity ◽

Retinal Vein Occlusion ◽

Macular Oedema ◽

Vision Loss ◽

Age Related Macular Degeneration ◽

Vein Occlusion ◽

Anti Vegf ◽

Age Related ◽

Treatment Naïve ◽

Randomised Controlled

Background/AimsTo assess visual acuity (VA) outcomes and antivascular endothelial growth factor (anti-VEGF) therapy intensity in retinal vein occlusion (RVO)-related macular oedema (ME).MethodsA retrospective study was completed in treatment-naïve patients with RVO-related ME from 2013 to 2019, using the Vestrum Health Retina Database.ResultsMean baseline age was 72.4 years and 54% were women. In 6 months, in 8876 eyes with branch retinal vein occlusion (BRVO)-related ME, after a mean of 4.5 anti-VEGF injections, VA increased by 9.4 letters (95% confidence interval (CI) for change in VA +8.94 to +9.78, p<0.001) from a baseline of 55.1 letters. In 6737 eyes with central retinal vein occlusion (CRVO)-related ME, after a mean of 4.6 anti-VEGF injections over 6 months, VA improved by 9.2 letters (95% CI +8.50 to +9.87, p<0.001) from a baseline of 37.2 letters. In 1 year, VA gain was similar (BRVO: 7.4 injections, +8.1 letters, 95% CI +7.55 to +8.57, p<0.001; CRVO: 7.6 injections, +7.1 letters, 95% CI +6.31 to +7.95, p<0.001). In 6 months and 1 year, mean letters gain increased with number of anti-VEGF injections. Patient eyes with baseline VA of 20/40 or better tended to lose VA in 1 year.ConclusionMean change in VA correlates with treatment intensity, but patients with better VA at presentation are susceptible to vision loss, reflecting a ceiling effect. Assessed with the same database, VA gains compare favourably with 1-year VA gains in neovascular age-related macular degeneration and diabetic ME, but exhibit a larger gap when compared with corresponding randomised controlled trials.

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The efficacy of dexamethasone implants following anti-VEGF failure for macular oedema in retinal vein occlusion

European Journal of Ophthalmology ◽

10.1177/1120672120978355 ◽

2020 ◽

pp. 112067212097835

Author(s):

Timothy E Yap ◽

Salman Husein ◽

Juan Antonio Miralles de Imperial-Ollero ◽

Benedetta Colizzi ◽

Maria Francesca Cordeiro ◽

...

Keyword(s):

Retinal Vein Occlusion ◽

Macular Oedema ◽

Functional Outcomes ◽

Retrospective Cohort ◽

Rescue Therapy ◽

Vein Occlusion ◽

Anti Vegf ◽

Central Subfield Thickness ◽

Secondary Outcomes ◽

Intravitreal Dexamethasone

Purpose: To investigate the efficacy of intravitreal dexamethasone implants (DEX) after anti-VEGF failure in retinal vein occlusion macular oedema. Methods: Retrospective cohort study of DEX implant (0.7 mg) given after anti-VEGF ‘failure’. Switch to DEX occurred if a ⩽ +5 ETDRS letter gain and ⩽20% reduction in central subfield thickness was present following ⩾6 consecutive anti-VEGF injections. The primary endpoint was VA change 30 days after DEX. Secondary outcomes were peak VA change, VA change at monthly timepoints, percentage achieving 15-letter gain, central subfield thickness (CST) and intraocular pressure (IOP). Results: Sixty-two injections in 62 patients associated with 26% central retinal vein occlusion (CRVO) and 74% branch retinal vein occlusion (BRVO) were eligible. There was a modest, significant improvement in mean VA change at 30 days compared to baseline (+6 letters, 95% CI +2.2 to +9.1 letters, p < 0.01). DEX implant significantly improved mean peak VA change compared to preceding anti-VEGF by +18.1 letters in CRVO ( p = 0.002) and +13.2 letters in BRVO ( p < 0.0001). IOP peaked between 30 and 60 days following injection, with 31% of CRVO and 11% of BRVO patients experiencing an IOP ⩾ 25 mmHg. Conclusion: DEX implant provides useful rescue therapy in cases of anti-VEGF ‘failure’ for macular oedema following retinal vein occlusion, resulting in improved functional outcomes at 30 days.

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Subthreshold laser therapy for macular oedema from branch retinal vein occlusion: focused review

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-315192 ◽

2020 ◽

pp. bjophthalmol-2019-315192

Author(s):

Victor Albert Eng ◽

Theodore Leng

Keyword(s):

Laser Therapy ◽

Retinal Vein Occlusion ◽

Macular Oedema ◽

Branch Retinal Vein Occlusion ◽

Vision Loss ◽

Cochrane Library ◽

Publication Date ◽

Micropulse Laser ◽

Vein Occlusion ◽

Subthreshold Laser

Retinal vein occlusion is the second-leading cause of vision loss by retinal vascular disease. Subthreshold micropulse laser therapy (SLT) is safer than conventional laser photocoagulation (CLP), yet existing reviews of its use for branch retinal vein occlusion (BRVO) are limited in scope. A literature search of PubMed, Google Scholar, Embase, Cochrane Library and ClinicalTrials.gov databases was conducted in August 2019 without restriction on language or publication date. Outcomes included changes in macular oedema (ME) and visual acuity (VA), and rates of complications or retreatments. Fourteen studies involving 315–405 eyes diagnosed with BRVO were evaluated. Treatment with SLT is associated with significant and durable reduction of ME and VA as early as 1 month. SLT performs comparably with conventional photocoagulation and intravitreal injections (IVIs) of ranibizumab. Subthreshold laser therapy is safer and as effective as CLP for the treatment of ME associated with BRVO. SLT may be used in combination with anti-VEGF IVIs to enhance improvement in VA and ME resolution.

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