光动力疗法与玻璃体腔注射抗血管内皮生长因子制剂治疗息肉样脉络膜血管病变的系统评价  

Efficacy evaluation of photodynamic therapy and intravitreal anti-vegf injection for polypoidal choroidal vasculopathy ： systematic review

作　　者：王静[1] 王尔茜[1] 陈有信[1] 田蓉[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院眼科,100730

出　　处：《中华眼科杂志》2013年第12期1094-1103,共10页Chinese Journal of Ophthalmology

摘　　要：目的系统评价单纯光动力疗法（PDT）、单纯玻璃体腔注射抗血管内皮生长因子（VEGF）制剂疗法和PDT联合玻璃体腔注射抗VEGF制剂治疗息肉样脉络膜血管病变（PCV）的有效性。方法系统评价。全面检索Pubmed、BiosisPreview、CochraneLibrary、Embase数据库有关PDT、抗VEGF治疗PCV的文献，按纳入和排除标准确定入选文献并根据设计方法分类。利用比较性研究对抗VEGF与PDT、抗VEGF与联合治疗、PDT与联合治疗进行荟萃分析和两两比较，主要终点为息肉样病灶的消退率，其他终点包括最佳矫正视力（BCVA）、黄斑中心凹视网膜厚度（CRT）、治疗次数等指标。结果共获得比较性临床试验13项，其中随机对照试验（RCT）1项，回顾性比较研究（RCS）12项，对上述3个治疗方案进行了两两比较；有4项研究对单纯抗VEGF和单纯PDT进行了比较，7项研究对单纯PDT和联合治疗进行了比较，4项研究对单纯抗VEGF和联合治疗进行了比较。综合考虑RCT及RCS结果：单纯PDT与单纯抗VEGF相比，6个月时病灶消退率更高（P=0．004），而BCVA、CRT在12个月随访范围内的差异无统计学意义（P〉0．05）；单纯PDT和联合治疗相比，虽然12个月时病灶消退率、BCVA、CRT的差异无统计学意义（P〉0．05），但在24个月时联合治疗组BCVA倾向于具有更好的视力（P=0．05），且联合治疗组所需PDT次数有所减少；联合治疗和单纯抗VEGF相比，12个月时病灶消退率显著增高，所需眼内注射次数较少，而BCVA、CRT的差异无统计学意义（P〉0．05）。结论单纯玻璃体腔注射抗VEGF制剂治疗在促进病灶消退方面不及单纯PDT或PDT联合玻璃体腔注射抗VEGF制剂治疗；联合治疗的远期（2年）视力可能优于单纯PDT。Objective To compare the efficacy of photodynamic therapy （PDT） alone, intravitreal anti-vascular endothelial growth factor （VEGF） therapy alone, and the combination of the two therapies for polypoid choroidal vaseulopathy （PCV）. Methods Systematic review. A computerized search was conducted in Pubmed, Biosis Preview, Cochrane Library, and Embase. Studies comparing any two of the above three treatment strategies were enrolled in the study. Meta-analysis of pairwise comparisons of the three approaches was conducted. The primary endpoint was the proportion of patients with complete regression of polyps. Other endpoints included best corrected visual acuity （BCVA）, central retinal thickness （CRT）, number of treatments. Results A total of 13 comparative studies were obtained,including 1 randomized controlled trials （RCT） and 12 retrospective comparative study （RCS）. Four studies compared anti-VEGF monotherapy with PDT monotherapy. Seven studies compared PDT monotherapy with combination therapy. Four studies compared anti-VEGF monotherapy with combination therapy. Considering the RCT and RCS results ： PDT was superior to anti-VEGF in achieving complete regression of polyps at month 6 （ P = 0. 004）, although BCVA and CRT showed no significant difference at 12-month follow-up. There was no significant difference in BCVA, CRT, and the proportion of patients with complete regression of polyps between PDT and combination group at 12 months follow-up. However, combination therapy showed more promising result in improving visual acuity at 24 months （ P = 0. 05 ）, with fewer PDT needed than in PDT monotherapy. Combination therapy was superior to anti-VEGF in achieving complete regression of polyps and the number of injections needed tended to be fewer. BCVA improvement and CRT reduction showed no significant difference at 12- month follow-up. Conclusion PDT with or without anti-VEGF therapy is superior to anti-VEGF monotherapy in achieving complete polyp regression,and combination therapy

关 键 词：脉络膜疾病 脉络膜出血 光化学疗法 玻璃体内注射 血管内皮生长因子 A Meta分析 评价研究 

分 类 号：R773[医药卫生—眼科]