Clinical Outcomes of Therapeutic Interventions for Autoimmune Retinopathy: A Meta-analysis and Systematic Review

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2024-09-12 DOI:10.1016/j.xops.2024.100622

Ishani Kapoor BS , Swara M. Sarvepalli MD, MS , Dilraj S. Grewal MD , Majda Hadziahmetovic MD

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引用次数: 0

Abstract

Topic

Autoimmune retinopathy (AIR) is a group of rare inflammatory diseases treated with immunosuppression; however, there is no treatment consensus. This meta-analysis and review aims to investigate treatment effectiveness in slowing AIR progression.

Clinical Relevance

Autoimmune retinopathy is a group of diseases characterized by progressive vision loss that is both difficult to diagnose and treat. While there is some consensus regarding diagnostic criteria, evidence-based treatment consensus remains poorly understood. Current first-line treatment is systemic steroids and conventional steroid-sparing agents. However, patients often experience treatment failure and systemic adverse effects with these medications. Understanding the effect of medications on slowing multiple visual outcomes in AIR can help to guide future treatment protocols.

Methods

PubMed, Cochrane Library, Embase, and ClinicalTrials.gov were systematically searched from inception to November 2023. Included studies treated patients with AIR with systemic, local, and biologic therapy and reported visual acuity (VA), visual field (VF), cystoid macular edema (CME), electroretinogram, central retinal thickness (CRT), and/or ellipsoid zone (EZ) loss. Risk of bias was assessed using the Critical Appraisal Skills Programme checklist. Data for meta-analysis were pooled using a random-effects model.

Results

Analysis of 40 case reports demonstrated that treatment type significantly affects the improvement of VA in patients with nonparaneoplastic retinopathy. Meta-analysis of 12 studies demonstrated that any treatment decreases the risk of progression of all 6 outcomes. Systemic therapy slows VA loss (risk ratio [RR] = 0.04, 95% confidence interval [0.00, 0.91], P = 0.04), VF loss (RR = 0.01, 95% confidence interval [0.00, 0.14], P = 0.0007), and CME (RR = 0.02, 95% confidence interval [0.00, 0.34], P = 0.007). Local therapy slows VA loss (RR = 0.02, 95% confidence interval [0.00, 0.12], P < 0.00001), CME (RR = 0.06, 95% confidence interval [0.01, 0.43], P = 0.005), CRT loss (RR = 0.02, 95% confidence interval [0.00, 0.36], P = 0.007), and EZ loss (RR = 0.31, 95% confidence interval [0.14, 0.70], P = 0.004). Biologics slow VA loss (RR = 0.28, 95% confidence interval [0.12, 0.65], P = 0.003), VF loss (RR = 0.25, 95% confidence interval [0.15, 0.42], P < 0.00001), and CRT loss (RR = 0.19, 95% confidence interval [0.04, 0.79], P = 0.02).

Conclusion

Systemic therapy significantly reduces the risk of progressive visual loss. Local therapy significantly decreases the risk of both progressive visual loss and retinal morphology loss, and therefore may offer precise targeting of the retina. Biologics significantly reduce both functional and morphological retinal changes. Immunosuppressive therapy may slow AIR progression; however, additional research is needed to assess long-term outcomes.

Financial Disclosures

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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自身免疫性视网膜病变治疗干预的临床结果：元分析和系统综述

主题自身免疫性视网膜病变（AIR）是一组罕见的炎症性疾病，可通过免疫抑制治疗；然而，治疗方法尚未达成共识。这项荟萃分析和综述旨在研究延缓自身免疫性视网膜病变进展的治疗效果。临床相关性自身免疫性视网膜病变是一组以进行性视力丧失为特征的疾病，既难以诊断也难以治疗。虽然人们对诊断标准已达成一定共识，但对循证治疗的共识仍知之甚少。目前的一线治疗方法是全身使用类固醇和传统的类固醇节省药物。然而，患者在使用这些药物时往往会出现治疗失败和全身不良反应。了解药物对减缓 AIR 多种视觉结果的影响有助于指导未来的治疗方案。方法系统检索了从开始到 2023 年 11 月的 PubMed、Cochrane Library、Embase 和 ClinicalTrials.gov。纳入的研究对AIR患者进行了全身、局部和生物治疗，并报告了视力（VA）、视野（VF）、囊样黄斑水肿（CME）、视网膜电图、视网膜中央厚度（CRT）和/或椭圆形区（EZ）损失。偏倚风险采用 "批判性评估技能计划 "核对表进行评估。结果对 40 份病例报告的分析表明，治疗类型对非副肿瘤性视网膜病变患者视力的改善有显著影响。对 12 项研究进行的 Meta 分析表明，任何治疗方法都会降低所有 6 种结果的恶化风险。全身治疗可减缓视力丧失（风险比 [RR] = 0.04，95% 置信区间 [0.00，0.91]，P = 0.04）、视力丧失（RR = 0.01，95% 置信区间 [0.00，0.14]，P = 0.0007）和 CME（RR = 0.02，95% 置信区间 [0.00，0.34]，P = 0.007）。局部治疗可减缓 VA 损失（RR = 0.02，95% 置信区间 [0.00，0.12]，P < 0.00001）、CME（RR = 0.06，95% 置信区间 [0.01，0.43]，P = 0.005）、CRT 损失（RR = 0.02，95% 置信区间 [0.00，0.36]，P = 0.007）和 EZ 损失（RR = 0.31，95% 置信区间 [0.14，0.70]，P = 0.004）。生物制剂可减缓 VA 损失（RR = 0.28，95% 置信区间 [0.12，0.65]，P = 0.003）、VF 损失（RR = 0.25，95% 置信区间 [0.15，0.42]，P <0.00001）和 CRT 损失（RR = 0.19，95% 置信区间 [0.04，0.79]，P = 0.02）。局部治疗可明显降低进行性视力丧失和视网膜形态丧失的风险，因此可提供精确的视网膜靶向治疗。生物制剂可明显减少视网膜的功能和形态变化。免疫抑制疗法可能会减缓AIR的进展；然而，还需要更多的研究来评估长期疗效。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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