Abstract
Background/Objectives
This meta-analysis investigates the efficacy and safety of intravitreal anti-VEGF injections (IVI) compared to combination laser photocoagulation and IVI (LPC-IVI) in treating macular oedema secondary to retinal vein occlusion (RVO).
Subjects/Methods
A literature search of MEDLINE, EMBASE and Cochrane CENTRAL was conducted from inception until March 2021. Randomized controlled trials that reported relevant efficacy and/or safety parameters following LPC-IVI relative to IVI were included. Meta-analysis was conducted with a random effects model. The primary outcome was best-corrected visual acuity (BCVA), while secondary outcomes were central macular thickness (CMT), central retinal thickness (CRT), central subfield thickness (CST), number of IVIs received, and incidence of adverse events.
Results
A total of 10 studies were included, for which 362 eyes were randomized to LPC-IVI and 365 to IVI. In comparing macular laser photocoagulation with IVI (MLP-IVI) in BRVO patients, no significant differences were seen in final BCVA (p = 0.78) or change in BCVA (p = 0.09) after treatment. Similarly, no significant differences were seen in final CMT (p = 0.54), change in CMT (p = 0.33), final CRT (p = 0.90), change in CRT (p = 0.97), or number of injections required (p = 0.78). The same results were seen in subgroup analyses for macular laser without peripheral laser in BRVO and CRVO patients. Consistent results were observed when considering peripheral LPC-IVI to IVI in BRVO and CRVO.
Conclusions
No significant differences were seen between combination MLP-IVI or peripheral LPC-IVI relative to IVI monotherapy for final BCVA or OCT parameters in macular oedema secondary to RVO.
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NB was responsible for screening potentially eligible studies, extracting and analyzing data, interpreting results, and writing the manuscript. APS contributed to data extraction, data analysis and critical revision of the manuscript. MMP was responsible for designing the review protocol, conducting the search, conducting the meta-analyses, interpreting results and critical revision of the manuscript. RHM and PJK assisted in designing the review protocol, interpreting results, and critical revision of the manuscript.
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MMP: Financial Support (to institution)—PSI Foundation. PJK: Advisory board—Novartis, Alcon, Bayer Roche, Novelty Nobility; Financial support (to institution)—Bayer, Roche, Novartis; Financial support—Novartis, Bayer; Equity owner—ArcticDx. RHM: Advisory board— Bayer, Novartis, Allergan, Roche; Financial Support (to institution)—Bayer, Novartis.
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Bhambra, N., Sayal, A.P., Popovic, M.M. et al. Combination intravitreal anti-vascular endothelial growth factor inhibitors and macular laser photocoagulation relative to intravitreal injection monotherapy in macular oedema secondary to retinal vein occlusion: a meta-analysis of randomized controlled trials. Eye 36, 2271–2278 (2022). https://doi.org/10.1038/s41433-021-01833-2
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DOI: https://doi.org/10.1038/s41433-021-01833-2
