Tiago N O Rassi, Lucas M Barbosa, Dillan Cunha Amaral, Ricardo N Louzada, Helvécio N F Filho, Guilherme N Marques, Breno C Vieira, Sobha Sivaprasad, Mauricio Maia
{"title":"荟萃分析:抗vegf与全视网膜光凝预防增殖性糖尿病视网膜病变严重并发症的长期/短期疗效","authors":"Tiago N O Rassi, Lucas M Barbosa, Dillan Cunha Amaral, Ricardo N Louzada, Helvécio N F Filho, Guilherme N Marques, Breno C Vieira, Sobha Sivaprasad, Mauricio Maia","doi":"10.1186/s40942-025-00687-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Studies diverge on the relevance of long-term protection of anti-VEGF against severe proliferative diabetic retinopathy (PDR) complications compared to pan-retinal photocoagulation (PRP). We aim to assess this dispute through a meta-analysis.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and Cochrane databases until August 2024 for studies comparing anti-VEGF with PRP in PDR. Primary outcomes were long-term and short-term incidences of VH, TRD, and PPV-setting short-term follow-up up to 2 years and long-term follow-up over 5 years. Due to a lack of consistent data, TRD events were not stratified by clinical severity. We also evaluated diabetic macular edema (DME) rates and changes in best corrected visual acuity (BCVA) and central macular thickness (CMT). We used R to pool risk ratios (RR) and weighted mean differences with a random-effects model, and appraised evidence certainty using the GRADE tool. PROSPERO CRD42024577668.</p><p><strong>Results: </strong>We included eight studies with 12,812 eyes. Long-term data showed anti-VEGF reducing TRD (3.4% vs. 11.5%; RR 0.31, 95% CI 0.23-0.42; p = 0.001) with high certainty of evidence. However, PPV (7.8% vs. 9.4%; p = 0.116) and VH rates (11% vs. 18%; p = 0.38) did not differ, with moderate and low evidence certainty, respectively. In the short term, anti-VEGF demonstrated superiority in BCVA and CMT outcomes and reduced DME rates.</p><p><strong>Conclusions: </strong>Although anti-VEGF was associated with lower TRD rates in the long term, the absence of severity data and the lack of differences in PPV and VH raise questions about its clinical relevance. Long-term findings are limited to only two studies. Future research should stratify TRD by severity and include extended follow-up. In contrast, short-term outcomes consistently favored anti-VEGF for both visual and anatomical results.</p>","PeriodicalId":14289,"journal":{"name":"International Journal of Retina and Vitreous","volume":"11 1","pages":"76"},"PeriodicalIF":1.9000,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239425/pdf/","citationCount":"0","resultStr":"{\"title\":\"Meta-analysis: long/short-term efficacy of anti-VEGF vs. panretinal photocoagulation in preventing severe complications in proliferative diabetic retinopathy.\",\"authors\":\"Tiago N O Rassi, Lucas M Barbosa, Dillan Cunha Amaral, Ricardo N Louzada, Helvécio N F Filho, Guilherme N Marques, Breno C Vieira, Sobha Sivaprasad, Mauricio Maia\",\"doi\":\"10.1186/s40942-025-00687-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Studies diverge on the relevance of long-term protection of anti-VEGF against severe proliferative diabetic retinopathy (PDR) complications compared to pan-retinal photocoagulation (PRP). We aim to assess this dispute through a meta-analysis.</p><p><strong>Methods: </strong>We searched PubMed, Embase, and Cochrane databases until August 2024 for studies comparing anti-VEGF with PRP in PDR. Primary outcomes were long-term and short-term incidences of VH, TRD, and PPV-setting short-term follow-up up to 2 years and long-term follow-up over 5 years. Due to a lack of consistent data, TRD events were not stratified by clinical severity. We also evaluated diabetic macular edema (DME) rates and changes in best corrected visual acuity (BCVA) and central macular thickness (CMT). We used R to pool risk ratios (RR) and weighted mean differences with a random-effects model, and appraised evidence certainty using the GRADE tool. PROSPERO CRD42024577668.</p><p><strong>Results: </strong>We included eight studies with 12,812 eyes. Long-term data showed anti-VEGF reducing TRD (3.4% vs. 11.5%; RR 0.31, 95% CI 0.23-0.42; p = 0.001) with high certainty of evidence. However, PPV (7.8% vs. 9.4%; p = 0.116) and VH rates (11% vs. 18%; p = 0.38) did not differ, with moderate and low evidence certainty, respectively. In the short term, anti-VEGF demonstrated superiority in BCVA and CMT outcomes and reduced DME rates.</p><p><strong>Conclusions: </strong>Although anti-VEGF was associated with lower TRD rates in the long term, the absence of severity data and the lack of differences in PPV and VH raise questions about its clinical relevance. Long-term findings are limited to only two studies. Future research should stratify TRD by severity and include extended follow-up. 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引用次数: 0
摘要
背景:与泛视网膜光凝(PRP)相比,抗vegf对严重增殖性糖尿病视网膜病变(PDR)并发症的长期保护作用的研究存在分歧。我们的目标是通过荟萃分析来评估这一争议。方法:我们检索PubMed, Embase和Cochrane数据库,直到2024年8月,以比较抗vegf与PRP在PDR中的研究。主要结局是VH、TRD和ppv的长期和短期发生率,短期随访2年以上,长期随访5年以上。由于缺乏一致的数据,TRD事件没有按临床严重程度分层。我们还评估了糖尿病性黄斑水肿(DME)发生率以及最佳矫正视力(BCVA)和黄斑中心厚度(CMT)的变化。我们使用随机效应模型的R来汇总风险比(RR)和加权平均差异,并使用GRADE工具评估证据确定性。普洛斯彼罗CRD42024577668。结果:我们纳入了8项研究,12,812只眼睛。长期数据显示抗vegf降低TRD (3.4% vs. 11.5%;Rr 0.31, 95% ci 0.23-0.42;P = 0.001),证据确定性高。然而,PPV (7.8% vs. 9.4%;p = 0.116)和VH率(11% vs. 18%;P = 0.38)无差异,证据确定性分别为中等和低。在短期内,抗vegf在BCVA和CMT结果中表现出优势,并降低了DME发生率。结论:尽管抗vegf与长期较低的TRD发生率相关,但缺乏严重程度数据以及PPV和VH缺乏差异,对其临床相关性提出了质疑。长期研究结果仅限于两项研究。未来的研究应根据严重程度对TRD进行分层,并包括长期随访。相反,在视觉和解剖结果方面,短期结果一致支持抗vegf。
Meta-analysis: long/short-term efficacy of anti-VEGF vs. panretinal photocoagulation in preventing severe complications in proliferative diabetic retinopathy.
Background: Studies diverge on the relevance of long-term protection of anti-VEGF against severe proliferative diabetic retinopathy (PDR) complications compared to pan-retinal photocoagulation (PRP). We aim to assess this dispute through a meta-analysis.
Methods: We searched PubMed, Embase, and Cochrane databases until August 2024 for studies comparing anti-VEGF with PRP in PDR. Primary outcomes were long-term and short-term incidences of VH, TRD, and PPV-setting short-term follow-up up to 2 years and long-term follow-up over 5 years. Due to a lack of consistent data, TRD events were not stratified by clinical severity. We also evaluated diabetic macular edema (DME) rates and changes in best corrected visual acuity (BCVA) and central macular thickness (CMT). We used R to pool risk ratios (RR) and weighted mean differences with a random-effects model, and appraised evidence certainty using the GRADE tool. PROSPERO CRD42024577668.
Results: We included eight studies with 12,812 eyes. Long-term data showed anti-VEGF reducing TRD (3.4% vs. 11.5%; RR 0.31, 95% CI 0.23-0.42; p = 0.001) with high certainty of evidence. However, PPV (7.8% vs. 9.4%; p = 0.116) and VH rates (11% vs. 18%; p = 0.38) did not differ, with moderate and low evidence certainty, respectively. In the short term, anti-VEGF demonstrated superiority in BCVA and CMT outcomes and reduced DME rates.
Conclusions: Although anti-VEGF was associated with lower TRD rates in the long term, the absence of severity data and the lack of differences in PPV and VH raise questions about its clinical relevance. Long-term findings are limited to only two studies. Future research should stratify TRD by severity and include extended follow-up. In contrast, short-term outcomes consistently favored anti-VEGF for both visual and anatomical results.
期刊介绍:
International Journal of Retina and Vitreous focuses on the ophthalmic subspecialty of vitreoretinal disorders. The journal presents original articles on new approaches to diagnosis, outcomes of clinical trials, innovations in pharmacological therapy and surgical techniques, as well as basic science advances that impact clinical practice. Topical areas include, but are not limited to: -Imaging of the retina, choroid and vitreous -Innovations in optical coherence tomography (OCT) -Small-gauge vitrectomy, retinal detachment, chromovitrectomy -Electroretinography (ERG), microperimetry, other functional tests -Intraocular tumors -Retinal pharmacotherapy & drug delivery -Diabetic retinopathy & other vascular diseases -Age-related macular degeneration (AMD) & other macular entities