Supplementary Material for: Anti-vascular endothelial growth factor treatment compared with steroid treatment for retinal vein occlusion: a meta-analysis

Background: This meta-analysis aims to compare the efficacy and safety of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents and intravitreal steroids for the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO). Methods: A systematic literature search was conducted on Ovid MEDLINE, EMBASE, and the Cochrane Controlled Register of Trials for studies published between January 2005 and November 2021. Randomized controlled trials (RCTs) reporting on patients with ME secondary to RVO who were treated with intravitreal steroids or anti-VEGF agents were included. A random effects meta-analysis was performed. Results: 867 eyes from 11 RCTs were included. At last study observation, intravitreal anti-VEGF agents were associated with a significantly better BCVA (WMD=-0.14 logMAR, 95% CI=[-0.19,-0.09], p<0.00001) and lower retinal thickness (WMD=-38.01 µm, 95% CI=[-56.17,-19.85], p<0.0001) relative to intravitreal steroids. Similar findings were found at 3-12 month timepoints. Intravitreal anti-VEGF agents were associated with a significantly lower incidence of IOP-related adverse events (RR=0.28, 95% CI=[0.15,0.51], p<0.0001), cataract development/progression (RR=0.22, 95% CI=[0.09,0.49], p=0.0003) and conjunctival hemorrhage (RR=0.52, 95% CI=[0.32,0.86], p=0.01). Conclusion: Our meta-analysis found superiority of intravitreal anti-VEGF agents relative to intravitreal steroids for the treatment of ME secondary to RVO with regards to visual acuity, anatomic outcomes, and safety endpoints.

背景：本项荟萃分析旨在对比玻璃体内抗血管内皮生长因子（anti-vascular endothelial growth factor, anti-VEGF）药物与玻璃体内糖皮质激素，治疗视网膜静脉阻塞（retinal vein occlusion, RVO）继发性黄斑水肿（macular edema, ME）的疗效与安全性。方法：本研究于2005年1月至2021年11月期间，在Ovid MEDLINE、EMBASE及Cochrane对照试验注册库中开展系统性文献检索。纳入以玻璃体内糖皮质激素或抗VEGF药物治疗的RVO继发性ME患者的随机对照试验（randomized controlled trial, RCT）。采用随机效应模型进行荟萃分析。结果：本分析共纳入11项RCT的867只患眼。末次随访时，相较于玻璃体内糖皮质激素，玻璃体内抗VEGF药物可显著改善最佳矫正视力（best corrected visual acuity, BCVA），加权均数差（weighted mean difference, WMD）=-0.14 logMAR，95%置信区间（confidence interval, CI）=[-0.19, -0.09]，p<0.00001；同时可降低视网膜厚度（WMD=-38.01 µm，95%CI=[-56.17, -19.85]，p<0.0001）。在3至12个月的随访时间点中亦得到相似结果。此外，玻璃体内抗VEGF药物的眼压相关不良事件发生率（相对危险度relative risk, RR=0.28，95%CI=[0.15, 0.51]，p<0.0001）、白内障发生/进展发生率（RR=0.22，95%CI=[0.09, 0.49]，p=0.0003）及结膜出血发生率（RR=0.52，95%CI=[0.32, 0.86]，p=0.01）均显著更低。结论：本项荟萃分析表明，在治疗RVO继发性ME时，相较于玻璃体内糖皮质激素，玻璃体内抗VEGF药物在视力、解剖学结局及安全性终点方面均展现出更优的治疗效果。