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Evidence summaries

Anti-Vegf for Macular Oedema Secondary to Central Retinal Vein Occlusion

Compared to no treatment, repeated intravitreal injection of anti-VEGF agents in eyes with central retinal vein occlusion macular oedema improves visual outcomes at 6 months. Level of evidence: "A"

Summary

A Cochrane review [Abstract] 1 included 6 studies with a total of 937 subjects comparing outcomes at 6 months to sham injection for 4 anti-vascular endothelial growth factor (anti-VEGF) agents: aflibercept (VEGF Trap-Eye, Eylea), bevacizumab (Avastin), pegaptanib sodium (Macugen) and ranibizumab (Lucentis). Treatment with anti-VEGF agents increased the chance of a significant gain in vision at 6 months compared to sham injections. One study demonstrated sustained benefit at 12 months. The risk of losing significant vision was reduced by 80% in those receiving anti-VEGF therapy compared to those receiving sham treatment. Participants receiving anti-VEGF treatment had a greater reduction in mean central retinal thickness from baseline to 6 months than patients receiving sham, indicating enhanced resolution of macular oedema (table T1). No significant safety concerns were identified at 6 or 12 months, but the available studies did not allow a conclusion about their long-term effectiveness and safety to be drawn.

Anti-VEGF compared with sham injection for central retinal vein occlusion macular oedema

OutcomeRelative effect (95% CI)Assumed risk - Sham injectionCorresponding risk - Anti-VEGF injection (95% CI)Participants (studies)
BCVA gain of 15 letters or moreRR 2.71 (2.10 to 3.49)182 per 1000493 per 1000(382 to 635)937(6 studies)
BCVA loss of 15 letters or moreRR 0.20 (0.12 to 0.34)219 per 100044 per 1000(26 to 74)766(5 studies)
Mean change from baseline in central retinal thicknessMD -267.4 µm (211.4 to 323.4)481(3 studies)
BCVA = best-corrected visual acuity
Clinical comments

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    References

    • Braithwaite T, Nanji AA, Lindsley K et al. Anti-vascular endothelial growth factor for macular oedema secondary to central retinal vein occlusion. Cochrane Database Syst Rev 2014;(5):CD007325. [PubMed]

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