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

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.

scholarly journals 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 ◽  
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.

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

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

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

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

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

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

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

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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