Review article
CHANGE OF VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITOR IN THE TREATMENT OF WET FORM OF SENILE MACULAR DEGENERATION: META-ANALYSIS AND LITERATURE REVIEW
DALIBOR OPAČIĆ
; Zagreb University Hospital Centre, University of Zagreb School of Medicine, Department of Ophthalmology, Zagreb, Croatia
ANTE VUKOJEVIĆ
; Zdenka Vukojević General Practice, Zagreb, Croatia
BERNARDA ŠKEGRO
; Sestre milosrdnice University Hospital Centre, Department of Rheumatology, Physical Medicine and Rehabilitation, Zagreb and Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
IVAN ŠKEGRO
; Zagreb University Hospital Centre, University of Zagreb School of Medicine, Department of Ophthalmology, Zagreb, Croatia
KREŠIMIR MANDIĆ
; Zagreb University Hospital Centre, University of Zagreb School of Medicine, Department of Ophthalmology, Zagreb, Croatia
MARIJA ŠTANFEL
; Zagreb University Hospital Centre, University of Zagreb School of Medicine, Department of Ophthalmology, Zagreb, Croatia
TOMISLAV JUKIĆ
; Zagreb University Hospital Centre, University of Zagreb School of Medicine, Department of Ophthalmology, Zagreb, Croatia
Abstract
The aim was to perform a systematic review and meta-analysis of scientifi c papers that analyzed treatment outcome in patients with exudative age-related macular degeneration after therapeutic switch from bevacizumab/ranibizumab to afl ibercept. Pubmed (Medline) and Science Citation Index expanded databases were searched over the last 5 years, with a combination of keywords. Clear criteria were defi ned, and evaluation of the best corrected visual acuity, with measurement of the central macular thickness by ocular coherence tomography before and after drug conversion was performed. Two meta-analyses have been published in recent literature analyzing studies with the results of treatment of resistant senile macular degeneration by conversion to afl ibercept, with somewhat similar inclusion criteria, the most important of which is the minimum six-month follow-up of patients after conversion therapy. The fi rst meta-analysis included 7 and the second 28 studies, prospective and retrospective. Both meta-analyses showed a signifi cant improvement in the central macular thickness after conversion to afl ibercept, while the improvement in visual acuity was very modest in one and unchanged in the other. Thus, a change in drug signifi cantly improved the anatomic outcome; however, no signifi cant improvement in visual function was observed. The reason is chronic illness and impairment, which implies a limited potential for vision recovery. Similar to the results of the previously mentioned meta-analyses, our analysis showed that improvement in the anatomic structure of the macula can be achieved by changing therapy. Finally, eleven of twenty studies that investigated the outcome of conversion from one anti-vascular endothelial growth factor drug to another were included in meta-analysis. The results showed a statistically signifi cant decrease in macular thickness after conversion to afl ibercept in all studies (overall signifi cance level p<0.001). The analysis performed showed a signifi cantly improved anatomic outcome, but visual improvement was found to be modest in only a few studies. This result could probably be explained by the fact that a longlasting chronic disease causes irreversible damage and prevents signifi cant functional recovery. Prospective studies with uniformly defi ned input criteria would allow better comparison of the results obtained after change in the treatment.
Keywords
intravitreal injections; macular degeneration; meta-analysis; vascular endothelial growth factor A
Hrčak ID:
245737
URI
Publication date:
6.11.2020.
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