Intravitreal Triamcinolone Acetonide for Diabetic Macular Edema and Macular Edema Secondary to Retinal Vein Occlusion: A Meta-Analysis.

IF 2.1 4区医学 Q2 OPHTHALMOLOGY

Ophthalmologica Pub Date : 2024-01-01 Epub Date: 2023-08-14 DOI:10.1159/000533443

Andrew Mihalache, Amin Hatamnejad, Nikhil S Patil, Marko M Popovic, Peter J Kertes, Miguel Cruz-Pimentel, Rajeev H Muni

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Abstract

Background: The comparative safety and efficacy of different doses of intravitreal triamcinolone acetonide (IVTA) for diabetic macular edema (DME) and macular edema (ME) secondary to retinal vein occlusion (RVO) is unclear.

Objectives: This meta-analysis aimed to compare the safety and efficacy of different doses of IVTA in this setting.

Methods: A systematic literature search for randomized clinical trials (RCTs) was conducted on Cochrane Library, Ovid MEDLINE, and EMBASE from January 2005 to May 2022. Studies that reported on patients with DME or ME secondary to RVO that received treatment with different doses of IVTA were included. A random-effects meta-analysis was performed. Cochrane's Risk of Bias Tool 2 was used to assess the risk of bias, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines were used to assess certainty of evidence.

Results: Five RCTs reporting on 1,041 eyes at baseline were included in this meta-analysis. In eyes with ME secondary to RVO, high-dose (4 mg) IVTA achieved a significantly better change in best-corrected visual acuity (WMD = -4.75 ETDRS letters, 95% CI = [-7.73, -1.78], p = 0.002) and reduction in retinal thickness (WMD = -93.02 μm, 95% CI = [-153.23, -32.82], p = 0.002) at months 4-6 compared to low-dose (1-2 mg) IVTA. However, high-dose IVTA had a higher risk of intraocular pressure-related adverse events (RR = 2.99, 95% CI = [1.05, 8.50], p = 0.04) and cataract surgery (RR = 5.67, 95% CI = [3.09, 10.41], p < 0.00001) than low-dose IVTA in eyes with ME secondary to RVO. These efficacy and safety differences in high-dose and low-dose IVTA were not observed in DME eyes.

Conclusions: The RCT evidence in this setting is limited. High-dose IVTA achieved greater improvements in visual acuity and reductions in retinal thickness than low-dose IVTA at months 4-6. However, high-dose IVTA had a less favorable safety profile than low-dose IVTA. The significance of these outcomes was based on patients with ME secondary to RVO, but not DME.

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静脉内曲安奈德治疗糖尿病黄斑水肿和视网膜静脉闭塞继发黄斑水肿：一项荟萃分析。

背景：不同剂量的玻璃体内曲安奈德（IVTA）治疗糖尿病黄斑水肿（DME）和视网膜静脉闭塞（RVO）继发的黄斑水肿（ME）的安全性和有效性比较尚不清楚：这项荟萃分析旨在比较不同剂量的IVTA在这种情况下的安全性和有效性：方法：2005 年 1 月至 2022 年 5 月，在 Cochrane Library、Ovid MEDLINE 和 EMBASE 上对随机临床试验 (RCT) 进行了系统性文献检索。这些研究报告了继发于 RVO 的 DME 或 ME 患者接受不同剂量 IVTA 治疗的情况。进行了随机效应荟萃分析。采用Cochrane的偏倚风险工具2评估偏倚风险，并采用建议、评估、发展和评价分级（GRADE）指南评估证据的确定性：本次荟萃分析共纳入了五项RCT研究，报告了1,041只眼睛的基线数据。与低剂量（1-2 毫克）IVTA 相比，在继发于 RVO 的 ME 患者中，高剂量（4 毫克）IVTA 在第 4-6 个月的最佳矫正视力变化（WMD=-4.75 ETDRS 字母，95%CI=[-7.73，-1.78]，p=.002）和视网膜厚度减少（WMD=-93.02 微米，95%CI=[-153.23，-32.82]，p=.002）方面取得了显著改善。然而，高剂量IVTA发生眼压相关不良事件（RR=2.99，95%CI=[1.05，8.50]，P=.04）和白内障手术（RR=5.67，95%CI=[3.09，10.41]，P=.41）的风险更高：这种情况下的 RCT 证据有限。与低剂量IVTA相比，高剂量IVTA在第4-6个月的视力改善和视网膜厚度减少方面取得了更大的进步。但是，高剂量 IVTA 的安全性不如低剂量 IVTA。这些结果的意义基于继发于RVO的ME患者，而非DME患者。

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来源期刊

Ophthalmologica 医学-眼科学

CiteScore

5.10

自引率

3.80%

发文量

审稿时长

3 months

期刊介绍： Published since 1899, ''Ophthalmologica'' has become a frequently cited guide to international work in clinical and experimental ophthalmology. It contains a selection of patient-oriented contributions covering the etiology of eye diseases, diagnostic techniques, and advances in medical and surgical treatment. Straightforward, factual reporting provides both interesting and useful reading. In addition to original papers, ''Ophthalmologica'' features regularly timely reviews in an effort to keep the reader well informed and updated. The large international circulation of this journal reflects its importance.