Intravitreal Anti-vascular Endothelial Growth Factor Injection for Retinopathy of Prematurity: A Systematic Review and Meta-Analysis

Frontiers in Medicine

article

Nada O. Taher¹  Abdullah A. Ghaddaf¹  Sarah A. Al-Ghamdi³  Jumanah J. Homsi⁴  Bandar J. Al-Harbi³  Lugean K. Alomari¹  Hashem S. Almarzouki¹ 

[1] College of Medicine, King Saud bin Abdulaziz University for Health Sciences;King Abdullah International Medical Research Center;Ophthalmology Saudi Board Program, Jeddah Eye Hospital;College of Medicine, King Abdulaziz University;Ophthalmology Saudi Board Program, King Abdulaziz University Hospital;Department of Ophthalmology, Ministry of the National Guard-Health Affairs

关键词: retinopathy of prematurity;    anti-vascular endothelial growth factor;    bevacizumab;    ranibizumab;    laser photocoagulation;   

DOI  :  10.3389/fmed.2022.884608

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background Laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections constitute the current standard treatment for retinopathy of prematurity (ROP). This systematic review and meta-analysis aimed to assess the efficacy and safety of anti-VEGF monotherapy for ROP treatment using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Methods We searched the Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. We included randomized controlled trials (RCTs) that compared intravitreal anti-VEGF monotherapy (e.g., bevacizumab, ranibizumab, aflibercept, and pegaptanib) with laser photocoagulation in preterm infants with ROP. We evaluated the rates of recurrence, treatment switching, retreatment, adverse events, and mortality. The risk ratio (RR) was used to represent dichotomous outcomes. Data were pooled using the inverse variance weighting method. The quality of evidence was assessed using the GRADE approach. Risk of bias was assessed using the Revised Cochrane risk of bias tool for randomized trials. Results Seven RCTs ( n = 579; 1,158 eyes) were deemed eligible. Three RCTs had an overall low risk of bias, three had some concerns, and one had an overall high risk of bias. The pooled effect estimate showed a statistically significant reduction in adverse events in favor of anti-VEGF monotherapy [RR = 0.17, 95% confidence interval (CI) 0.07–0.44]. The pooled analysis showed no significant difference between the anti-VEGF and laser groups in terms of recurrence rate (RR = 1.56, 95% CI 0.23–10.54), treatment switching (RR = 2.92, 95% CI 0.40–21.05), retreatment (RR = 1.56, 95% CI 0.35–6.96), and mortality rate (RR = 1.28, 95% CI 0.48–3.41). Conclusion Overall, intravitreal anti-VEGF monotherapy was associated with fewer adverse events than laser therapy, rated as high quality of evidence according to the GRADE criteria. Pooled analysis revealed no significant difference between the two arms with respect to the recurrence rate, treatment switching, retreatment, and mortality rate, with quality of evidence ranging from moderate to very low as per the GRADE approach.

【 授权许可】

CC BY