AI Article Synopsis

  • The study investigates whether anti-VEGF therapy can slow down retinal non-perfusion (RNP) progression in diabetic retinopathy (DR) compared to laser treatments or sham.
  • A systematic review and meta-analysis of randomized controlled trials showed that anti-VEGF therapy may reduce RNP progression over 12 and 24 months, but the evidence is rated as low certainty due to some limitations.
  • The findings suggest that while anti-VEGF treatment could slightly influence RNP progression, more research is needed to clarify its effectiveness and the impact of specific treatment factors.

Article Abstract

Purpose: Retinal non-perfusion (RNP) is fundamental to disease onset and progression in diabetic retinopathy (DR). Whether anti-vascular endothelial growth factor (anti-VEGF) therapy can modify RNP progression is unclear. This investigation quantified the impact of anti-VEGF therapy on RNP progression compared with laser or sham at 12 months.

Methods: A systematic review and meta-analysis of randomised controlled trials (RCTs) were performed; Ovid MEDLINE, EMBASE and CENTRAL were searched from inception to 4th March 2022. The change in any continuous measure of RNP at 12 months and 24 months was the primary and secondary outcomes, respectively. Outcomes were reported utilising standardised mean differences (SMD). The Cochrane Risk of Bias Tool version-2 and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines informed risk of bias and certainty of evidence assessments.

Results: Six RCTs (1296 eyes) and three RCTs (1131 eyes) were included at 12 and 24 months, respectively. Meta-analysis demonstrated that RNP progression may be slowed with anti-VEGF therapy compared with laser/sham at 12 months (SMD: -0.17; 95% confidence interval [CI]: -0.29, -0.06; p = 0.003; I  = 0; GRADE rating: LOW) and 24-months (SMD: -0.21; 95% CI: -0.37, -0.05; p = 0.009; I  = 28%; GRADE rating: LOW). The certainty of evidence was downgraded due to indirectness and due to imprecision.

Conclusion: Anti-VEGF treatment may slightly impact the pathophysiologic process of progressive RNP in DR. The dosing regimen and the absence of diabetic macular edema may impact this potential effect. Future trials are needed to increase the precision of the effect and inform the association between RNP progression and clinically important events.

Prospero Registration: CRD42022314418.

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Source
http://dx.doi.org/10.1111/aos.15673DOI Listing

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