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Systematic literature review of treatments for management of complications of ischemic central retinal vein occlusion.

Bradshaw SE, Gala S, Nanavaty M, Shah A, Mwamburi M, Kefalas P - BMC Ophthalmol (2016)

Bottom Line: Most treatments did not improve visual acuity significantly.There is a lack of evidence for any intervention being effective in iCRVO, especially in the prevention of neovascularisation. iCRVO poses a significant clinical and economic burden.There is a need to standardize the definition of ischemia, and for innovative treatments which can significantly improve visual outcomes and prevent neovascular complications.

View Article: PubMed Central - PubMed

Affiliation: Valid Insight®, Kemp House, 152 City Road, London, EC1V 2NX, UK. sbradshaw@validinsight.com.

ABSTRACT

Background: To understand the clinical and economic outcomes of treatments for managing complications of ischemic central retinal vein occlusion (iCRVO).

Methods: We conducted a systematic literature review by searching multiple databases and ophthalmology conferences from 2004 to 2015. Studies published in English language and populations of age ≥45 years were included. For clinical endpoints, we defined eligibility criteria as randomized controlled trials, prospective before-and-after study designs, and non-randomized studies reporting on treatments in patients with iCRVO. For economic endpoints, all types of study design except cost-of-illness studies were included. We evaluated the definitions of ischemia, clinical and economic endpoints, and rate of development of complications. Risk of bias was assessed for clinical studies using the Cochrane risk-of-bias tool.

Results: A total of 20 studies (1338 patients) were included. Treatments included anti-vascular endothelial growth factors (anti-VEGFs), steroids, and procedures primarily targeting macular edema and neovascularization. Ischemia was not defined consistently in the included studies. The level of evidence was mostly low. Most treatments did not improve visual acuity significantly. Development of treatment complications ranged from 11 to 57 %. Incremental cost-effectiveness ratios reported for anti-VEGFs and steroids were below the accepted threshold of GB£30,000, but considering such treatments only ameliorate disease symptoms they seem relatively expensive.

Conclusions: There is a lack of evidence for any intervention being effective in iCRVO, especially in the prevention of neovascularisation. iCRVO poses a significant clinical and economic burden. There is a need to standardize the definition of ischemia, and for innovative treatments which can significantly improve visual outcomes and prevent neovascular complications.

No MeSH data available.


Related in: MedlinePlus

PRISMA 2009 flow diagram. CRVO = central retinal vein occlusion
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Fig1: PRISMA 2009 flow diagram. CRVO = central retinal vein occlusion

Mentions: A total of 1891 de-duplicated study abstracts including 130 conference abstracts were screened, of which 20 studies (13 reporting clinical outcomes and seven reporting economic outcomes) were included in the final assessment. A flow diagram summarizing the study attrition is shown in Fig. 1.Fig. 1


Systematic literature review of treatments for management of complications of ischemic central retinal vein occlusion.

Bradshaw SE, Gala S, Nanavaty M, Shah A, Mwamburi M, Kefalas P - BMC Ophthalmol (2016)

PRISMA 2009 flow diagram. CRVO = central retinal vein occlusion
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940864&req=5

Fig1: PRISMA 2009 flow diagram. CRVO = central retinal vein occlusion
Mentions: A total of 1891 de-duplicated study abstracts including 130 conference abstracts were screened, of which 20 studies (13 reporting clinical outcomes and seven reporting economic outcomes) were included in the final assessment. A flow diagram summarizing the study attrition is shown in Fig. 1.Fig. 1

Bottom Line: Most treatments did not improve visual acuity significantly.There is a lack of evidence for any intervention being effective in iCRVO, especially in the prevention of neovascularisation. iCRVO poses a significant clinical and economic burden.There is a need to standardize the definition of ischemia, and for innovative treatments which can significantly improve visual outcomes and prevent neovascular complications.

View Article: PubMed Central - PubMed

Affiliation: Valid Insight®, Kemp House, 152 City Road, London, EC1V 2NX, UK. sbradshaw@validinsight.com.

ABSTRACT

Background: To understand the clinical and economic outcomes of treatments for managing complications of ischemic central retinal vein occlusion (iCRVO).

Methods: We conducted a systematic literature review by searching multiple databases and ophthalmology conferences from 2004 to 2015. Studies published in English language and populations of age ≥45 years were included. For clinical endpoints, we defined eligibility criteria as randomized controlled trials, prospective before-and-after study designs, and non-randomized studies reporting on treatments in patients with iCRVO. For economic endpoints, all types of study design except cost-of-illness studies were included. We evaluated the definitions of ischemia, clinical and economic endpoints, and rate of development of complications. Risk of bias was assessed for clinical studies using the Cochrane risk-of-bias tool.

Results: A total of 20 studies (1338 patients) were included. Treatments included anti-vascular endothelial growth factors (anti-VEGFs), steroids, and procedures primarily targeting macular edema and neovascularization. Ischemia was not defined consistently in the included studies. The level of evidence was mostly low. Most treatments did not improve visual acuity significantly. Development of treatment complications ranged from 11 to 57 %. Incremental cost-effectiveness ratios reported for anti-VEGFs and steroids were below the accepted threshold of GB£30,000, but considering such treatments only ameliorate disease symptoms they seem relatively expensive.

Conclusions: There is a lack of evidence for any intervention being effective in iCRVO, especially in the prevention of neovascularisation. iCRVO poses a significant clinical and economic burden. There is a need to standardize the definition of ischemia, and for innovative treatments which can significantly improve visual outcomes and prevent neovascular complications.

No MeSH data available.


Related in: MedlinePlus