Lai SC, Loh EW, Chiou DI, Hong CT. Efficacy and safety of anti-vascular endothelial growth factor agents on corneal neovascularization: A meta-analysis. World J Clin Cases 2023; 11(30): 7337-7349 [PMID: 37969435 DOI: 10.12998/wjcc.v11.i30.7337]
Corresponding Author of This Article
Chien-Tai Hong, MD, PhD, Associate Professor, Department of Neurology, School of Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan. ct.hong@tmu.edu.tw
Research Domain of This Article
Ophthalmology
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 26, 2023; 11(30): 7337-7349 Published online Oct 26, 2023. doi: 10.12998/wjcc.v11.i30.7337
Efficacy and safety of anti-vascular endothelial growth factor agents on corneal neovascularization: A meta-analysis
Shih-Chung Lai, El-Wui Loh, Du-I Chiou, Chien-Tai Hong
Shih-Chung Lai, Du-I Chiou, Department of Ophthalmology, Shuang Ho Hospital, New Taipei City 23561, Taiwan
El-Wui Loh, Center for Evidence-Based Health Care, Department of Medical Research, Taipei Medical University Shuang Ho Hospital, New Taipei City 23561, Taiwan
El-Wui Loh, Cochrane Taiwan, Taipei Medical University, Taipei 110, Taiwan
El-Wui Loh, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
El-Wui Loh, Department of Medical Imaging, Taipei Medical University Shuang Ho Hospital, New Taipei City 23561, Taiwan
Chien-Tai Hong, Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei 23561, Taiwan
Co-corresponding authors: Du-I Chiou and Chien-Tai Hong.
Author contributions: Lai SC, Chiou DI, Loh EW, and Hong CT contributed to study conception and design; Lai SC, Chiou DI, and Loh EW contributed to data acquisition and analysis; Chiou DI and Loh EW contributed to data interpretation; Lai SC and Chiou DI contributed to manuscript writing and revision; Hong CT and Loh EW contributed to provision of resources and administrative oversight; Chiou DI and Hong CT contributed equally.
Conflict-of-interest statement: All authors declared no competing interests
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chien-Tai Hong, MD, PhD, Associate Professor, Department of Neurology, School of Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan. ct.hong@tmu.edu.tw
Received: July 27, 2023 Peer-review started: July 27, 2023 First decision: September 26, 2023 Revised: September 26, 2023 Accepted: October 8, 2023 Article in press: October 8, 2023 Published online: October 26, 2023
Abstract
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.
Core Tip: Vascular endothelial growth factor (VEGF) inhibitor is one of the pharmacological options for treating corneal neovascularization (CoNV) - the second major cause of blindness. The present study conducted a systematic review and meta-analysis support the use of Bevacizumab in the treatment of CoNV. The results of our study supports that anti-VEGF agents are effective in reducing CoNV, best-corrected visual acuity, and graft rejection/failure rate. In addition, our study found evidence supporting the improvement of visual acuity which was not significant in the previous systematic review and meta-analysis.
