Treatments for managing the complications of ischemic central and retinal vein occlusions: A systematic literature review

The objective of this study was to gain insight into the clinical and economic outcomes associated with treatments for the management of complications of ischemic central retinal vein occlusion (iCRVO).

By searching through several databases and opthalmology conferences between 2004 to 2015, a systemic literature review was conducted that included studies published in English and populations of age ≥45 years.Clinical endpoints were limited to randomized controlled trials, prospective before-and-after study designs, and non-randomized studies reporting on treatments in patients with iCRVO, while economic endpoints included all types of study design except cost-of-illness studies. The review assessed the definitions of ischemia, clinical and economic endpoints, and the rate of development of complications. To evaluate the risk of bias in clinical studies, the Cochrane risk-of-bias tool was utilized.

20 studies (1338 patients) were included in the report. 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 generally low. Significant improvements in visual acuity were not achieved by most treatments. 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, however, these treatments still seem relatively expensive given that they only alleviate disease symptoms.

It was determined that the effectiveness of interventions for iCRVO, particularly in preventing neovascularisation, is currently lacking sufficient evidence. iCRVO has a notable impact on both clinical and economic aspects. There is a pressing need to establish a standardized definition of ischemia and to develop innovative treatments that can greatly enhance visual outcomes while also preventing neovascular complications.

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