首页|The 12-and 24-Month Effects of Intravitreal Ranibizumab, Aflibercept, and Bevacizumab on Intraocular Pressure A Network Meta-Analysis

The 12-and 24-Month Effects of Intravitreal Ranibizumab, Aflibercept, and Bevacizumab on Intraocular Pressure A Network Meta-Analysis

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  • NSTL
  • Elsevier
Topic: To investigate the effect of anti-vascular endothelial growth factor (VEGF) therapy on intraocular pressure (IOP) 12 and 24 months after initiation. Clinical Relevance: It is unclear whether serial anti-VEGF injections result in sustained IOP increases. Methods: Randomized controlled trials (RCTs) comparing anti-VEGF agents with each other or with controls for the treatment of neovascular age-related macular degeneration, retinal vein occlusions, or diabetic macular edema were included. Pairwise meta-analysis and Bayesian network meta-analysis examined the proportion of patients whose IOP (1) increased 5 mmHg or more from baseline on consecutive visits, (2) increased 10 mmHg or more from baseline at any visit, (3) was 21 mmHg or more on consecutive visits, (4) was 25 mmHg or more at any visit, (5) was 30 mmHg or more at any visit, (6) prompted initiation of IOP-lowering medications, or (7) increased as per the clinicians' discretion. Grading of Recommendations Assessments, Development, and Evaluations methodology informed the certainty of evidence. Results: Twenty-six RCTs of 12 522 eyes were included. Aflibercept, bevacizumab, ranibizumab (0.3 mg and 0.5 mg), and noninjection controls were analyzed. Eighty-three of 84 network estimates for comparisons between anti-VEGF agents demonstrated no statistically significant difference (low to moderate certainty of evidence). Ranibizumab 0.5 mg showed higher rates than bevacizumab of IOP measurements of 30 mmHg or more at 12 months (low certainty of evidence). Fifty-three of 56 network estimates for comparisons between anti-VEGF agents and controls demonstrated no statistically significant difference (low to moderate certainty of evidence). Ranibizumab 0.5 mg showed higher rates of consecutive IOP increases of 5 mmHg or more at 24 months (low certainty of evidence) and higher rates of IOP increases as per the clinicians' discretion at 12 and 24 months (low and very low certainty of evidence, respectively). The 95% credible intervals in comparisons without statistically significant effects did not rule out important clinical effects. The certainty of evidence in these comparisons is limited by imprecision. Conclusion: This network meta-analysis does not show any clear difference in !OP increases 12 and 24 months after treatment initiation between anti-VEGF agents and controls. Imprecision precludes definitive conclusions. (C) 2021 by the American Academy of Ophthalmology

Anti-VEGF therapyDiabetic macular edemaNeovascular age-relatedmacular degenerationOcular hypertensionRetinal vein occlusionANTERIOR-CHAMBER PARACENTESISGROWTH-FACTOR AGENTSMACULAR DEGENERATIONSUSTAINED ELEVATIONINJECTIONLASERMETAANALYSISMONOTHERAPYTRIALRISK

Sarohia, Gurkaran S.、Kennedy, Kevin、Ceyhan, Tiandra、McKechnie, Tyler、Phillips, Mark、Devji, Tahira、Nanji, Keean、Thabane, Lehana、Kaiser, Peter、Sarraf, David、Garg, Sunir J.、Sivaprasad, Sobha、Wykoff, Charles C.、Bakri, Sophie J.、Sheidow, Tom、Bhandari, Mohit、Chaudhary, Varun

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Dept Ophthalmol & Visual Sci,Univ Alberta

Dept Hlth Res Methods Evidence & Impact,McMaster Univ

Dept Ophthalmol,Queens Univ

Dept Surg,McMaster Univ

Temerty Fac Med,Univ Toronto

Cole Eye Inst,Cleveland Clin

Stein Eye Inst,Univ Calif Los Angeles

Retina Serv,Wills Eye Hosp & Res Inst

NIHR Moorfields Biomed Res Ctr,Moorfields Eye Hosp

Texas & Blanton Eye Inst,Houston Methodist Hosp

Dept Ophthalmol,Mayo Clin

Ivey Eye Inst,Univ Western Ontario

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2022

10.1016/j.ophtha.2021.11.024

Ophthalmology

Ophthalmology

ISTP
ISSN：0161-6420
年,卷(期)：2022.129(5)
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