title: Treatments for macular oedema following central retinal vein occlusion: systematic review.
abstract: OBJECTIVE
  To review systematically the randomised controlled trial (RCT) evidence for treatment of macular oedema due to central retinal vein occlusion (CRVO).
  
  
  METHODS
  MEDLINE, EMBASE, CDSR, DARE, HTA, NHSEED, CENTRAL and meeting abstracts (January 2005 to March 2013).
  
  
  METHODS
  RCTs with at least 12 months of follow-up assessing pharmacological treatments for CRVO were included with no language restrictions.
  
  
  METHODS
  2 authors screened titles and abstracts and conducted data extracted and Cochrane risk of bias assessment. Meta-analysis was not possible due to lack of comparable studies.
  
  
  RESULTS
  8 studies (35 articles, 1714 eyes) were included, assessing aflibercept (n=2), triamcinolone (n=2), bevacizumab (n=1), pegaptanib (n=1), dexamethasone (n=1) and ranibizumab (n=1). In general, bevacizumab, ranibizumab, aflibercept and triamcinolone resulted in clinically significant increases in the proportion of participants with an improvement in visual acuity of ≥15 letters, with 40-60% gaining ≥15 letters on active drugs, compared to 12-28% with sham. Results for pegaptanib and dexamethasone were mixed. Steroids were associated with cataract formation and increased intraocular pressure. No overall increase in adverse events was found with bevacizumab, ranibizumab, aflibercept or pegaptanib compared with control. Quality of life was poorly reported. All studies had a low or unclear risk of bias.
  
  
  CONCLUSIONS
  All studies evaluated a relatively short primary follow-up (1 year or less). Most had an unmasked extension phase. There was no head-to-head evidence. The majority of participants included had non-ischaemic CRVO.
  
  
  CONCLUSIONS
  Bevacizumab, ranibizumab, aflibercept and triamcinolone appear to be effective in treating macular oedema secondary to CRVO. Long-term data on effectiveness and safety are needed. Head-to-head trials and research to identify 'responders' is needed to help clinicians make the right choices for their patients. Research aimed to improve sight in people with ischaemic CRVO is required.
authors: Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
authors: John A
authors: JA
authors: Ford
authors: Christine
authors: C
authors: Clar
authors: Noemi
authors: N
authors: Lois
authors: Samantha
authors: S
authors: Barton
authors: Sian
authors: S
authors: Thomas
authors: Rachel
authors: R
authors: Court
authors: Deepson
authors: D
authors: Shyangdan
authors: Norman
authors: N
authors: Waugh
mesh_terms: D006801:Humans; D008269:Macular Edema / Q000188:drug therapy* / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D012170:Retinal Vein Occlusion / Q000150:complications* / Q000188:drug therapy*; D014792:Visual Acuity
keywords: Anti-VEGF; Central Retinal Vein Occlusion; Macular Oedema; Systematic Review