Effectiveness and safety of anti-vascular endothelial growth factor therapies for macular edema in retinal vein occlusion: A systematic review and network meta-analysis of randomized controlled trials.

Abstract

We evaluated the efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) therapies for macular edema (ME) secondary to retinal vein occlusion (RVO), a leading cause of vision loss. A comprehensive search of 6 databases identified 17 RCTs involving 4272 eyes. Eligible studies reported outcomes such as visual acuity, ETDRS letter scores, central retinal thickness (CRT), and adverse events, with follow-up of at least 6 months. Anti-VEGF therapy showed significant efficacy, with a pooled mean difference (MD) of 15.14 ETDRS letters (95 % CI: 14.24-16.03, p < 0.001). Over 12 months, patients were 2.87 times more likely to achieve gains of > 15 ETDRS letters (OR 2.87, 95 % CI: 2.21-3.72). CRT decreased by MD of -350 µm (95 % CI: -0.363 to -0.338, p < 0.001). Safety analysis revealed reduced treatment-related adverse events (TRAEs) (OR 0.88, p = 0.035) with no significant systemic risks. Intraocular pressure elevation (OR 1.924, p < 0.001) warrants monitoring. Subgroup analysis highlighted faricimab as most effective, with aflibercept, ranibizumab, and bevacizumab providing substantial benefits. Anti-VEGF therapy is an effective, safe cornerstone for managing ME in RVO. Further research should explore biomarkers and combination treatments to refine therapeutic approaches.