Unit:
Speciality Medical and Surgical Retina Modern ApproachesLibrary of the School of Health Sciences
Author:
Mavridou Eleftheria
Supervisors info:
Ειρήνη Χατζηράλλη, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Θεόδωρος Σεργεντάνης, Επίκουρος Καθηγητής, Τμήμα Πολιτικών Δημόσιας Υγείας, ΠΑΔΑ
Παναγιώτης Θεοδοσιάδης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Evaluation of treatment with intravitreal injections of anti-vascular endothelial growth factor agents in patients with neovascular age-related macular degeneration and retinal pigment epithelial tear: a systematic review and meta-analysis
Translated title:
Evaluation of treatment with intravitreal injections of anti-vascular endothelial growth factor agents in patients with neovascular age-related macular degeneration and retinal pigment epithelial tear: a systematic review and meta-analysis
Summary:
Neovascular age-related macular degeneration (nAMD) represents a significant cause of chronic visual impairment in the elderly, primarily due to the exudative and hemorrhagic consequences of choroidal neovascularization (CNV). The cornerstone of nAMD management involves the intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents, which, despite their efficacy, are associated with complications, including retinal pigment epithelial (RPE) tears. RPE tears arise from the contraction of the CNV membrane, exerting tension on the RPE layer during anti-VEGF therapy. The purpose of this systematic review and meta-analysis is to evaluate the outcomes of continuing versus discontinuing intravitreal anti-VEGF treatment at various follow-up time points in nAMD patients who developed RPE tears following anti-VEGF therapy.
Relevant publications were identified through a systematic search in the PubMed and EMBASE databases. The inclusion criteria were specifically designed to identify studies reporting on patients with nAMD undergoing anti-VEGF treatment, who subsequently developed RPE tears. The data extraction process focused on the functional and anatomical outcomes, as well as the management approaches regarding the continuation or cessation of intravitreal anti-VEGF treatment following an RPE tear. The standardized mean differences (SMD), with their 95% confidence intervals (95% CI), were estimated using random effects models (DerSimonian-Laird), as appropriate. Meta-regression analysis was also performed.
Thirty studies (including 479 eyes with RPE tear) were eligible for the systematic review and meta-analysis. These studies examined the outcomes in patients who continued anti-VEGF treatment post-tear and those who discontinued it, with comparisons made separately for different time points in each group. In patients who continued anti-VEGF treatment, the pooled best-corrected visual acuity (BCVA) showed no significant difference compared to baseline at any follow-up time point. The pooled central subfield thickness (CST) improved at 12 months but did not reach a significant level. Long-term follow-up indicated a decrease in subretinal and intraretinal fluid. In patients who discontinued intravitreal anti-VEGF treatment, there was a non-significant improvement in BCVA within the first 3 months; however, BCVA fluctuated or worsened over time, and fibrosis development was observed.
This systematic review and meta-analysis provides an evidence-based overview of RPE tears in the context of intravitreal anti-VEGF therapy for nAMD. The findings underscore the importance of careful assessment and management of patients with RPE tears, including considerations on the continuation of intravitreal anti-VEGF therapy, to mitigate the risk of further visual acuity decline while maximizing therapeutic benefits.
Main subject category:
Health Sciences
Keywords:
Neovascular age-related macular degeneration, Anti-VEGF, Retinal pigment epithelium tear, Systematic review, Meta-analysis
Number of references:
127
File:
File access is restricted until 2025-07-15.
POSTGRADUATE_THESIS_Eleftheria_Mavridou_final.pdf
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File access is restricted until 2025-07-15.
