Abstract
Objectives: The aim of this study is to systematically review the evidence for anti-VEGF therapy in choroidal neovascularisation secondary to conditions other than age related macular degeneration.
Data sources: MEDLINE, MEDLINE in-process, EMBASE and CENTRAL databases and conference abstracts were searched (from inception to Jan 2014).
Study eligibility criteria, participants and interventions: Randomised and non-randomised comparative studies with follow-up of at least six months were included were used to assess clinical effectiveness.
Study appraisal and synthesis method: Risk of bias was assessed using Cochrane risk of bias tool and modified Newcastle-Ottawa scale. Meta-analysis was not possible due to methodological heterogeneity.
Results: Sixteen studies met the inclusion criteria (1,091 eyes; 963 pathological myopia, 74 other conditions). There was large variation in risk of bias across studies. An improvement in best-corrected visual acuity in anti-VEGF arms over comparators was reported in all studies. The proportion of patients improving by at least 15 letters in anti-VEGF arms ranged from 27.3 - 70%. There were no significant differences between bevacizumab and ranibizumab.
Limitations: Due to the rarity of choroidal neovascularisation secondary to conditions other than age related macular degeneration or pathological myopia, there are unlikely to ever be sufficiently powered trials in these populations
Conclusions: Bevacizumab and ranibizumab appear to be effective in improving visual acuity for patients with choroidal neovascularisation secondary to conditions other than age related macular degeneration. The evidence base is strongest for choroidal neovascularisation secondary to pathological myopia, however based on current evidence and likely pharmacological pathways clinicians should consider treatment with either bevacizumab or ranibizumab for rarer causes.
Data sources: MEDLINE, MEDLINE in-process, EMBASE and CENTRAL databases and conference abstracts were searched (from inception to Jan 2014).
Study eligibility criteria, participants and interventions: Randomised and non-randomised comparative studies with follow-up of at least six months were included were used to assess clinical effectiveness.
Study appraisal and synthesis method: Risk of bias was assessed using Cochrane risk of bias tool and modified Newcastle-Ottawa scale. Meta-analysis was not possible due to methodological heterogeneity.
Results: Sixteen studies met the inclusion criteria (1,091 eyes; 963 pathological myopia, 74 other conditions). There was large variation in risk of bias across studies. An improvement in best-corrected visual acuity in anti-VEGF arms over comparators was reported in all studies. The proportion of patients improving by at least 15 letters in anti-VEGF arms ranged from 27.3 - 70%. There were no significant differences between bevacizumab and ranibizumab.
Limitations: Due to the rarity of choroidal neovascularisation secondary to conditions other than age related macular degeneration or pathological myopia, there are unlikely to ever be sufficiently powered trials in these populations
Conclusions: Bevacizumab and ranibizumab appear to be effective in improving visual acuity for patients with choroidal neovascularisation secondary to conditions other than age related macular degeneration. The evidence base is strongest for choroidal neovascularisation secondary to pathological myopia, however based on current evidence and likely pharmacological pathways clinicians should consider treatment with either bevacizumab or ranibizumab for rarer causes.
| Original language | English |
|---|---|
| Article number | e007746 |
| Journal | BMJ Open |
| Volume | 5 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 3 May 2015 |