title: Drug treatment of macular oedema secondary to central retinal vein occlusion: a network meta-analysis.
abstract: OBJECTIVE
  To indirectly compare aflibercept, bevacizumab, dexamethasone, ranibizumab and triamcinolone for treatment of macular oedema secondary to central retinal vein occlusion using a network meta-analysis (NMA).
  The following databases were searched from January 2005 to March 2013: MEDLINE, MEDLINE In-process, EMBASE; CDSR, DARE, HTA, NHSEED, CENTRAL; Science Citation Index and Conference Proceedings Citation Index-Science.
  
  
  METHODS
  Only randomised controlled trials assessing patients with macular oedema secondary to central retinal vein occlusion were included. Studies had to report either proportions of patients gaining ≥3 lines, losing ≥3 lines, or the mean change in best corrected visual acuity. Two authors screened titles and abstracts, extracted data and undertook risk of bias assessment. Bayesian NMA was used to compare the different interventions.
  
  
  RESULTS
  Seven studies, assessing five drugs, were judged to be sufficiently comparable for inclusion in the NMA. For the proportions of patients gaining ≥3 lines, triamcinolone 4 mg, ranibizumab 0.5 mg, bevacizumab 1.25 mg and aflibercept 2 mg had a higher probability of being more effective than sham and dexamethasone. A smaller proportion of patients treated with triamcinolone 4 mg, ranibizumab 0.5 mg or aflibercept 2 mg lost ≥3 lines of vision compared to those treated with sham. Patients treated with triamcinolone 4 mg, ranibizumab 0.5 mg, bevacizumab 1.25 mg and aflibercept 2 mg had a higher probability of improvement in the mean best corrected visual acuity compared to those treated with sham injections.
  
  
  CONCLUSIONS
  We found no evidence of differences between ranibizumab, aflibercept, bevacizumab and triamcinolone for improving vision. The antivascular endothelial growth factors (VEGFs) are likely to be favoured because they are not associated with steroid-induced cataract formation. Aflibercept may be preferred by clinicians because it might require fewer injections.
  
  
  BACKGROUND
  Not registered.
authors: Department of Population Health and Primary Care, University of East Anglia, Norwich, UK.
authors: John A
authors: JA
authors: Ford
authors: Warwick Evidence, University of Warwick, Coventry, UK.
authors: Deepson
authors: D
authors: Shyangdan
authors: Warwick Evidence, University of Warwick, Coventry, UK.
authors: Olalekan A
authors: OA
authors: Uthman
authors: Centre for Vision and Vascular Science, Queen's University, Belfast, UK.
authors: Noemi
authors: N
authors: Lois
authors: Warwick Evidence, University of Warwick, Coventry, UK.
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*