title: Systematic literature review of treatments for management of complications of ischemic central retinal vein occlusion.
abstract: BACKGROUND
  To understand the clinical and economic outcomes of treatments for managing complications of ischemic central retinal vein occlusion (iCRVO).
  
  
  METHODS
  We conducted a systematic literature review by searching multiple databases and ophthalmology conferences from 2004 to 2015. Studies published in English language and populations of age ≥45 years were included. For clinical endpoints, we defined eligibility criteria as randomized controlled trials, prospective before-and-after study designs, and non-randomized studies reporting on treatments in patients with iCRVO. For economic endpoints, all types of study design except cost-of-illness studies were included. We evaluated the definitions of ischemia, clinical and economic endpoints, and rate of development of complications. Risk of bias was assessed for clinical studies using the Cochrane risk-of-bias tool.
  
  
  RESULTS
  A total of 20 studies (1338 patients) were included. Treatments included anti-vascular endothelial growth factors (anti-VEGFs), steroids, and procedures primarily targeting macular edema and neovascularization. Ischemia was not defined consistently in the included studies. The level of evidence was mostly low. Most treatments did not improve visual acuity significantly. Development of treatment complications ranged from 11 to 57 %. Incremental cost-effectiveness ratios reported for anti-VEGFs and steroids were below the accepted threshold of GB£30,000, but considering such treatments only ameliorate disease symptoms they seem relatively expensive.
  
  
  CONCLUSIONS
  There is a lack of evidence for any intervention being effective in iCRVO, especially in the prevention of neovascularisation. iCRVO poses a significant clinical and economic burden. There is a need to standardize the definition of ischemia, and for innovative treatments which can significantly improve visual outcomes and prevent neovascular complications.
authors.affiliation: Valid Insight®, Kemp House, 152 City Road, London, EC1V 2NX, UK. sbradshaw@validinsight.com.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Bradshaw
authors.affiliation: Valid Insight®, Kemp House, 152 City Road, London, EC1V 2NX, UK.
authors.forename: Smeet
authors.initials: S
authors.lastname: Gala
authors.affiliation: Market Access Solutions, 575 State Route 28, Raritan, NJ, 08869, USA.
authors.forename: Merena
authors.initials: M
authors.lastname: Nanavaty
authors.affiliation: Market Access Solutions, 575 State Route 28, Raritan, NJ, 08869, USA.
authors.forename: Anshul
authors.initials: A
authors.lastname: Shah
authors.affiliation: Market Access Solutions, 575 State Route 28, Raritan, NJ, 08869, USA.
authors.forename: Mkaya
authors.initials: M
authors.lastname: Mwamburi
authors.affiliation: Cell Therapy Catapult, 12th Floor Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK.
authors.forename: Panos
authors.initials: P
authors.lastname: Kefalas
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D005901:Glaucoma / Q000209:etiology / Q000628:therapy; D006801:Humans; D008269:Macular Edema / Q000209:etiology / Q000628:therapy; D009389:Neovascularization, Pathologic / Q000209:etiology / Q000628:therapy; D013508:Ophthalmologic Surgical Procedures; D012164:Retinal Diseases / Q000209:etiology / Q000628:therapy; D012170:Retinal Vein Occlusion / Q000150:complications* / Q000628:therapy*; D013256:Steroids / Q000627:therapeutic use*
chemical_list: D020533:Angiogenesis Inhibitors; D013256:Steroids