Comparison between anti- VEGF therapy and corticosteroid or laser therapy for macular oedema secondary to retinal vein occlusion: A meta-analysis.

What is known and objective Therapeutic effects of anti- VEGF agents, corticosteroids and laser therapy have been previously examined for treating macular oedema secondary to branch and central retinal vein occlusion ( BRVO and CRVO). However, anti- VEGF efficacy has not been previously compared to corticosteroid or laser therapy efficacy. We performed a meta-analysis to compare these treatments. Methods Pertinent publications were identified through comprehensive literature searches. Therapeutic effects were estimated using best-corrected visual acuity ( BCVA), central retinal thickness ( CRT) and intraocular pressure ( IOP). The Review Manager (version 5.3.5) was used to perform searches. Results and discussion Eleven randomized, controlled trials that included 1045 RVO patients were identified. For eyes with BRVO, anti- VEGF therapy improved BCVA significantly more than corticosteroid/laser therapy at 3 ( P=.0002), 6 ( P<.00001) and 12 months ( P<.00001). For eyes with CRVO, this difference was only significant at 6 months ( P=.002). The same was true when efficacy was examined using CRT at 3 and 6 months ( BRVO: both P<.00001, CRVO 6 months: P=.02). Long-term efficacy of anti- VEGF agents was limited in eyes with BRVO and CRVO. Improvements in BCVA were similar at 1 and 3 months ( P=.74), but BCVA decreased between 3 and 6 months ( P=.03). In contrast, BCVA progressively decreased 1 and 6 months following corticosteroid/laser therapy (both P<.00001). Lastly, eyes that had been treated with anti- VEGF agents had significantly lower IOP changes than eyes treated with corticosteroids/laser 3 and 6 months after initiating therapy (both P<.00001). What is new and conclusion Anti- VEGF agents improve BCVA and reduce CRT more effectively and longer than corticosteroid/laser in eyes with RVO. Anti- VEGF agents also have a lower risk of elevating IOP. Additionally, anti- VEGF agents are more effective for treating BRVO than CRVO. [ABSTRACT FROM AUTHOR]