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目的综合评价玻璃体腔注射贝伐单抗(IVB)与玻璃体腔注射曲安奈德(IVT)对比治疗视网膜分支静脉阻塞(BR-VO)继发黄斑水肿时的疗效与安全性的差异。设计荟萃分析(Meta分析)。研究对象Medline(1966-2012年)、EMbase(1966-2011年)、Cochrane图书馆(2011年)及中国生物医学文献数据库(CBM)(1979-2011年)有关贝伐单抗与曲安奈德对比治疗BR-VO继发黄斑水肿的临床对照研究文献资料。方法采用Cochrane系统评价的方法,检索上述文献,按照纳入和排除标准限定研究对象,通过Jadad评分量表进行文献质量评估后,使用Cochrane协作网提供的RevMan 5.1统计软件进行Meta分析,以获得两种治疗BRVO继发黄斑水肿的疗效及安全性是否有差异的相关证据。主要指标中央黄斑厚度(CMT),最佳矫正视力(BC-VA),不良反应。结果共纳入IVB与IVT对比治疗BRVO继发黄斑水肿的临床对照研究8项(共376眼)。Meta分析结果显示,首选IVB组与首选IVT组的患者CMT降低幅度的差异为12.76μm(95%CI,-7.74~33.26μm,P=0.22);提高BCVA幅度的差异为0.11(95%CI,-0.00~0.23,P=0.06)。首选IVT组发生不良反应的比例是首选IVB组的20倍(95%CI,8.3~50倍,P=0.000)。结论采用首选IVB与IVT对比治疗BRVO继发黄斑水肿时,在降低CMT及提高BCVA方面两者疗效相仿,但安全性方面IVT明显较IVB差。二者间谁更适合作为BRVO继发黄斑水肿的首选治疗,尚需更多前瞻性大样本的临床随机对照试验数据支持。
Objective To evaluate the efficacy and safety of vitreous cavity injection of bevacizumab (IVB) and vitreous cavity injection of triamcinolone acetonide (IVT) in the treatment of secondary macular edema in retinal branch vein occlusion (BR-VO). Design meta-analysis (Meta-analysis). Subjects Medline (1966-2012), EMbase (1966-2011), The Cochrane Library (2011) and China Biomedical Literature Database (CBM) (1979-2011) for bevacizumab versus triamcinolone acetonide Treatment of BR-VO secondary macular edema clinical control study literature. Methods The Cochrane review was used to retrieve the above-mentioned articles. Subjects were screened for inclusion and exclusion criteria. The quality of the literature was assessed using the Jadad Rating Scale. Meta-analysis was performed using the RevMan 5.1 statistical software available from the Cochrane Collaboration to obtain two Therapeutic efficacy of BRVO secondary macular edema and the safety of the evidence is relevant. The main indicators of central macula thickness (CMT), best corrected visual acuity (BC-VA), adverse reactions. Results A total of 8 controlled trials (376 eyes) of IVC with IVT in the treatment of secondary macular edema in BRVO were included. Meta-analysis showed that the difference in CMT reduction was 12.76 μm (95% CI, -7.74 to 33.26 μm, P = 0.22) for patients preferred IVB and those preferred IVT, and 0.11 (95% CI, -0.00 ~ 0.23, P = 0.06). Adverse reactions in the preferred IVT group were 20 times more likely to be in the IVB group (95% CI, 8.3-50 fold, P = 0.000). Conclusions The treatment of macular edema secondary to BRVO by the first choice of IVB vs IVT is similar in reducing CMT and increasing BCVA, but the safety of IVT is significantly lower than that of IVB. Who is better suited as the first choice of treatment of secondary macular edema in BRVO remains to be supported by more prospective, large-scale clinical RCT data.