抗VEGF类药物与曲安奈德玻璃体腔注射治疗视网膜中央静脉阻塞继发黄斑水肿的Meta分析  

Meta-analysis of the effect of intravitreal anti-VEGF drugs versus intravitreal triamcinolone in macular edema caused by central retinal vein occlusion

作　　者：张鹏[1] 马景学[1] 

机构地区：[1]河北医科大学第二医院眼科,石家庄050000

出　　处：《中华实验眼科杂志》2016年第12期1097-1101,共5页Chinese Journal Of Experimental Ophthalmology

摘　　要：背景视网膜中央静脉阻塞（CRVO）是常见的视网膜血管病，黄斑水肿是其常见的并发症及患者视力下降的主要原因，玻璃体腔注射抗血管内皮生长因子（VEGF）类药物及曲安奈德已成为治疗黄斑水肿的重要手段。目的系统评价抗VEGF类药物与曲安奈德治疗CRVO并发黄斑水肿的临床疗效。方法按照检索策略检索PubMed、Cochrane图书馆、EMbase、中国知网（CNKI）、维普（VIP）和万方数据库，查找关于抗VEGF药物与曲安奈德治疗CRVO并发黄斑水肿的临床对照试验。检索时限均为从建库至2015年9月，按照纳入和排除标准筛选文献、提取数据资料，并对纳入的文献进行质量评价。采用Revman5．3软件对连续变量进行合并效应量检测。结果共纳入7篇文献，共包括345例患者348眼患眼。抗VEGF药物组与曲安奈德组术后6个月最佳矫正视力和黄斑中心凹厚度比较差异均无统计学意义[平均差（MD）=-0．03，95％置信区间（CI）：-0．11～0．05，P=0．52；MD=-15．37，95％CI：-36．29～5．55，P=0．15]，眼压比较差异有统计学意义（MD=-2．73，95％CI：-3．59- -1．86，P〈0．00001）。曲安奈德组中22眼出现晶状体混浊，8眼出现眼压升高。抗VEGF药物组中仅2眼出现晶状体混浊。结论中期随访内，玻璃体腔注射抗VEGF类药物与曲安奈德均可提高CRVO并发黄斑水肿患者的最佳矫正视力并减轻黄斑水肿，二者疗效相当，但曲安奈德眼压升高等不良反应的发生率高于抗VEGF类药物。Background Central retinal vein occlusion （CRVO） is a common retinal vascular disease. Macular edema is a common complication and can lead to the decrease of visual acuity. Intravitreal injection of anti- vascular endothelial growth factor （VEGF） drugs and triamcinolonc acetonide has become the important treatment on macular edema. Objective This study was to systematically evaluate the clinical effects of anti-VEGF drugs and triamcinolone in patients with macular edema caused by CRVO. Methods The Databases including PubMed, Coehrane Library （Issue 11,2012）, EMbase, CBM, CNKI, VIP and WanFang Database were electronically searched for the trials about the effects of anti-VEGF drugs and triameinolone in patients with maeular edema caused by CRVO from the date of establishment of the databases to September 2015. The combined effect was analyzed by using Review Manager 5.3 software. Results A total 7 trials involving 345 patients and 348 eyes were included. Meta-analysis showed that there was no statistical difference in best corrected visual acuity （BCVA） and macular central thickness between anti-VEGF drugs and triameinolone in the 6-month follow-up （mean difference [ MD ] =- 0. 03,95% confidence interval[ CI] ： -0. 11 - 0.05 ,P = 0.52 ; MD = - 15.37,95% CI： -36.29 -5.55, P = 0.15 ） , but there was statistical difference in intraocular pressure （ MD = -2.73,95% CI： -3.59- - 1.86, P〈0. 000 01 ）. Twenty-two cases of lens opacity and 8 cases elevated intraoeular pressure were observed in the triameinolone group. Only 2 cases of lens opacity were observed in the anti-VEGF drugs group. Conclusions Anti-VEGF drugs and triameinolone have similar improvement of BCVA and decrease of macular central thickness in CRVO patients,while the triamcinolone is accompanied with more side effects such as high intraocular pressure and progressing cataract.

关 键 词：视网膜中央静脉阻塞 黄斑水肿 曲安奈德 血管内皮生长因子 

分 类 号：R774[医药卫生—眼科]