Systematic literature review of treatments for management of complications of ischemic central retinal vein occlusion

BMC Ophthalmology

Research Article

Panos Kefalas¹  Merena Nanavaty²  Anshul Shah²  Mkaya Mwamburi²  Smeet Gala³  Steven E. Bradshaw³ 

[1] Cell Therapy Catapult, 12th Floor Tower Wing, Guy’s Hospital, Great Maze Pond, SE1 9RT, London, UK;Market Access Solutions, 575 State Route 28, 08869, Raritan, NJ, USA;Valid Insight®, Kemp House, 152 City Road, EC1V 2NX, London, UK;

关键词: Macular Edema;    Ranibizumab;    Well Corrected Visual Acuity;    Aflibercept;    Central Retinal Vein Occlusion;   

DOI  :  10.1186/s12886-016-0282-5

 received in 2015-12-02, accepted in 2016-06-13,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundTo understand the clinical and economic outcomes of treatments for managing complications of ischemic central retinal vein occlusion (iCRVO).MethodsWe conducted a systematic literature review by searching multiple databases and ophthalmology conferences from 2004 to 2015. Studies published in English language and populations of age ≥45 years were included. For clinical endpoints, we defined eligibility criteria as randomized controlled trials, prospective before-and-after study designs, and non-randomized studies reporting on treatments in patients with iCRVO. For economic endpoints, all types of study design except cost-of-illness studies were included. We evaluated the definitions of ischemia, clinical and economic endpoints, and rate of development of complications. Risk of bias was assessed for clinical studies using the Cochrane risk-of-bias tool.ResultsA total of 20 studies (1338 patients) were included. Treatments included anti-vascular endothelial growth factors (anti-VEGFs), steroids, and procedures primarily targeting macular edema and neovascularization. Ischemia was not defined consistently in the included studies. The level of evidence was mostly low. Most treatments did not improve visual acuity significantly. Development of treatment complications ranged from 11 to 57 %. Incremental cost-effectiveness ratios reported for anti-VEGFs and steroids were below the accepted threshold of GB£30,000, but considering such treatments only ameliorate disease symptoms they seem relatively expensive.ConclusionsThere is a lack of evidence for any intervention being effective in iCRVO, especially in the prevention of neovascularisation. iCRVO poses a significant clinical and economic burden. There is a need to standardize the definition of ischemia, and for innovative treatments which can significantly improve visual outcomes and prevent neovascular complications.

【 授权许可】

CC BY   
© The Author(s). 2016