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Efficacy and safety of anti-vascular endothelial growth factor agents on corneal neovascularization: A meta-analysis
Shih-Chung Lai1, El-Wui Loh2,3,4,5, Du-I Chiou1
1Department of Ophthalmology, Shuang Ho Hospital, New Taipei City 23561, Taiwan.
Background:
Corneal neovascularization (CoNV) is the second major cause of blindness. Vascular endothelial growth factor (VEGF) inhibitors, e.g., bevacizumab, have been used to prevent CoNV.
Aim:
We conducted an updated systematic review and meta-analysis of clinical trials to examine the efficacy and safety of anti-VEGF in CoNV.
Methods:
A literature search was conducted using three electronic databases. Mean difference (MD), standard mean difference (SMD), and relative risk (RR) are used to estimate the effect size.
Results:
Nine randomized controlled and three non-randomized trials were obtained. The pooled results demonstrated a significant reduction of CoNV area/Length (SMD = -1.17, 95%CI: -1.58 to -0.75), best corrected visual acuity (MD = -0.54, 95%CI: -0.91 to -0.17), and graft rejection (RR = 0.44, 95%CI: 0.24 to 0.8) and failure (RR = 0.39, 95%CI: 0.19 to 0.78) rates in the anti-VEGF group than the placebo group. A non-significant reduction of the epithelial defect was also observed in the bevacizumab group compared with the placebo (RR = 0.56, 95%CI: 0.30 to 1.06). Compared with a placebo, the unsynthesizable trials also support that bevacizumab improves visual acuity, CoNV, graft rejection, and failure rates. Trials reporting other comparisons revealed the superiority of combined remedy with bevacizumab compared to other treatments in reducing CoNV.
Conclusion:
Anti-VEGF agents, mainly bevacizumab, are an effective and safe treatment for CoNV of all causes and prevent corneal graft rejection and failure in corneal transplantation.
Insights
Anti-vascular endothelial growth factor (VEGF) agents, primarily bevacizumab, effectively treat corneal neovascularization (CoNV). This meta-analysis confirms their safety and efficacy in reducing CoNV, improving vision, and preventing graft rejection and failure.
Area of Science:
- Ophthalmology
- Regenerative Medicine
- Vascular Biology
Background:
- Corneal neovascularization (CoNV) is a significant cause of vision loss.
- Anti-vascular endothelial growth factor (VEGF) therapies, such as bevacizumab, are utilized to manage CoNV.
Purpose of the Study:
- To conduct an updated systematic review and meta-analysis.
- To evaluate the efficacy and safety of anti-VEGF agents in treating CoNV.
Main Methods:
- Systematic literature search across three electronic databases.
- Meta-analysis using Mean Difference (MD), Standard Mean Difference (SMD), and Relative Risk (RR) for effect size estimation.
- Inclusion of randomized controlled and non-randomized trials.
Main Results:
- Significant reductions in CoNV area/length (SMD = -1.17), improved best-corrected visual acuity (MD = -0.54), and decreased graft rejection (RR = 0.44) and failure rates (RR = 0.39) were observed with anti-VEGF treatment.
- Non-significant reduction in epithelial defects.
- Bevacizumab demonstrated efficacy in improving visual acuity, CoNV, graft rejection, and failure rates.
- Combination therapy with bevacizumab showed superiority in reducing CoNV compared to other treatments.
Conclusions:
- Anti-VEGF agents, particularly bevacizumab, represent effective and safe treatments for CoNV.
- These agents successfully prevent corneal graft rejection and failure in transplantation settings.
- The findings support the use of anti-VEGF therapy for various causes of CoNV.
