О стандарте лечения макулярного отёка при тромбозах вен сетчатки

Подоспел новый систематический обзор и мета-анализ. Нового в принципе ничего: мы ещё раз удостоверились, что с этой целью анти-VEGF препараты лучше стероидов, что их надо применять как можно скорее после события, и что при тромбозе ветви с отёком в макуле фокальныйм/ секторальный лазер по сетчатке полезен, а при тромбозе центральной вены - нет.

"Clin Exp Ophthalmol. 2023 May-Jun;51(4):313-338. doi: 10.1111/ceo.14225. Epub 2023 Apr 14.

Management of macular oedema due to retinal vein occlusion: An evidence-based systematic review and meta-analysis.

Cornish EE(1)(2)(3), Zagora SL(1)(2)(4), Spooner K(5)(6), Fraser-Bell S(1)(2)(7).

Author information: (1)Sydney Medical School, Discipline of Ophthalmology and Eye Health, Save Sight Institute, The University of Sydney, Sydney, Australia. (2)Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia. (3)Department of Ophthalmology, Westmead Hospital, Westmead, Australia. (4)Department of Ophthalmology, The Sydney Children's Hospital Network, Westmead, Australia. (5)Sydney Retina Clinic, Sydney, Australia. (6)Roche Australia (Roche had no affiliation with this work), Millers Point, Australia. (7)Department of Ophthalmology, Royal North Shore Hospital, St Leonards, Australia.

BACKGROUND: Central retinal vein occlusion and branch retinal vein occlusion are common causes of visual loss due to associated macular oedema. The aim of this review was to assess the effectiveness of interventions improving vision and treating macular oedema in central retinal vein occlusion and branch retinal vein occlusion. METHODS: Medical search engines and clinical trial registries were systematically searched. Randomised clinical trials with ≥90 eyes and real-world outcome studies with ≥100 eyes each with ≥6 months follow-up were included. RESULTS: There were 11 randomised controlled trials evaluating treatments for central retinal vein occlusion which met the inclusion criteria and 10 for branch retinal vein occlusion. There were 10 real world outcome studies of central retinal vein occlusion and 5 real world outcome studies of branch retinal vein occlusion. Meta-analysis was performed on studies that met the defined inclusion criteria. Main outcomes were change in visual acuity at 6-, 12-, 24- and 36 months by treatment. CONCLUSIONS: Intravitreal anti-vascular endothelial derived growth factor is recommended as first line treatment over intravitreal corticosteroid due to its effectiveness and lower rate of ocular adverse events. Best outcomes are achieved when intravitreal treatment is started early. Macular laser may have an adjunctive role in branch retina vein occlusion but not central retinal vein occlusion"