非感染性视网膜血管炎治疗的临床试验和准实验研究:来自国际葡萄膜炎研究组(IUSG)视网膜血管炎研究(修订)的系统综述-报告4。

IF 5.9 2区 医学 Q1 OPHTHALMOLOGY
Paola Saboya-Galindo, Carlos Cifuentes-González, William Rojas-Carabali, Germán Mejía-Salgado, Yong Le Tong, Ikhwanuliman Putera, Xin Ying Rachel Song, Cheong Fu Yuan Walter, Zhang Shengjuan, Reo Chan, Rina La Distia Nora, Jyotirmay Biswas, Sapna Gangaputra, Jose S Pulido, John H Kempen, Quan Dong Nguyen, Alejandra de-la-Torre, Vishali Gupta, James T Rosenbaum, Rupesh Agrawal
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引用次数: 0

摘要

本系统综述评估了报告诊断标准、疾病活动性评分系统(包括疾病活动性指数(DAI)、总炎症活动性指数(TIAI)和总调整疾病活动性指数(TADAI)等)以及用于非感染性视网膜血管炎(RV)的治疗策略的临床试验和准实验研究,旨在巩固目前关于治疗反应和有效性措施的证据。在筛选的5533篇文章中(PROSPERO: CRD42023489232),有15项研究符合纳入标准。大多数研究在亚洲进行(73.3%),重点是behaperet病(60%)或Eales病(27%)。所有研究均临床诊断为RV,其中一半采用荧光素血管造影,通过渗漏、染色或闭塞来确认血管炎症;然而,RV的定义是高度可变的,通常是推断而不是明确说明,并且缺乏标准化。这种诊断的不一致性,加上有限的成像数据,破坏了研究之间的可比性。疾病活动性的评估使用过时的复合指数,如DAI、TIAI和TADAI,这些指数缺乏外部验证,无法捕捉关键的临床特征,如黄斑缺血或毛细血管非灌注。最佳矫正视力,虽然经常报道,是混淆的不相关因素,如白内障或黄斑疤痕。治疗策略包括全身皮质类固醇、免疫抑制剂(如甲氨蝶呤、硫唑嘌呤)和生物制剂(如英夫利昔单抗、干扰素- α)。治疗选择是不均匀的,一些方案——如环磷酰胺-硫唑嘌呤联合用药——不符合当前的治疗标准。由于研究设计和结果报告的可变性,没有进行汇总效应估计或统计比较。治疗结果根据个别研究结果进行描述性综合。目前RV临床试验的证据是过时的,缺乏诊断和治疗的标准化。我们特别需要rv特异性的定义、经过验证的疾病活动性和反应指数,以及当代治疗试验来指导临床管理和提高结果的可比性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical trials and quasi-experimental studies in the treatment of noninfectious retinal vasculitis: A Systematic Review from the International Uveitis Study Group (IUSG) Retinal Vasculitis Study (ReViSe) - Report 4.

This systematic review evaluates clinical trials and quasi-experimental studies reporting diagnostic criteria, disease activity scoring systems (including Disease Activity Index (DAI), Total Inflammatory Activity Index (TIAI), and Total Adjusted Disease Activity Index (TADAI), and others), and therapeutic strategies used in noninfectious retinal vasculitis (RV), aiming to consolidate current evidence on treatment response and effectiveness measures. Of 5,533 articles screened (PROSPERO: CRD42023489232), 15 studies met the inclusion criteria. Most were conducted in Asia (73.3%) and focused on Behçet disease (60%) or Eales disease (27%). RV was diagnosed clinically in all studies, while half incorporated fluorescein angiography to confirm vascular inflammation through leakage, staining, or occlusion; however, definitions of RV were highly variable, often inferred rather than explicitly stated, and lacked standardization. This diagnostic inconsistency, combined with limited imaging data, undermines comparability across studies. Disease activity was assessed using outdated composite indices such as the DAI, TIAI, and TADAI, which lack external validation and fail to capture key clinical features such as macular ischemia or capillary non-perfusion. Best corrected visual acuity, although frequently reported, was confounded by unrelated factors such as cataracts or macular scarring. Therapeutic strategies included systemic corticosteroids, immunosuppressants (e.g., methotrexate, azathioprine), and biologics (e.g., infliximab, interferon-alpha). Treatment selection was heterogeneous, and several regimens-such as cyclophosphamide-azathioprine combinations-do not align with current standards of care. Due to variability in study design and outcome reporting, no pooled effect estimates, or statistical comparisons were conducted. Treatment outcomes were synthesized descriptively based on individual study findings. Current evidence in RV clinical trials is outdated and lacks diagnostic and therapeutic standardization. There is a particular need for RV-specific definitions, validated disease activity and response indices, and contemporary therapeutic trials to guide clinical management and improve outcome comparability.

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来源期刊
Survey of ophthalmology
Survey of ophthalmology 医学-眼科学
CiteScore
10.30
自引率
2.00%
发文量
138
审稿时长
14.8 weeks
期刊介绍: Survey of Ophthalmology is a clinically oriented review journal designed to keep ophthalmologists up to date. Comprehensive major review articles, written by experts and stringently refereed, integrate the literature on subjects selected for their clinical importance. Survey also includes feature articles, section reviews, book reviews, and abstracts.
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