A systematic review and meta-analysis to compare the efficacy of conbercept with ranibizumab in patients with macular edema secondary to retinal vein occlusion

Intravitreal Injection of Conbercept Combined with Dexamethasone for Macular Edema Following Central Retinal Vein Occlusion

Background

To compare the efficacy of intravitreal injections of Conbercept combined with dexamethasone (DEX) for macular edema (ME) following central retinal vein occlusion (CRVO).

Methods

This was a prospective, single-masked, randomised, controlled clinical trial. Patients with ME following CRVO were randomised into groups to receive intravitreal injections of 0.5 mg Conbercept plus 0.2 mg DEX or 0.5 mg Conbercept alone on day 0 followed by repeat injections as indicated. The primary outcome measure was the change in best-corrected visual acuity (BCVA) from baseline to month 12. Secondary outcome measures included decrease in central retinal thickness (CRT), injection frequency and interval and percentage of patients who gained more than 15 ETDRS letters or achieved a CRT of < 250 μm at month 12.

Results

33 males (51%) and 32 females (49%) were initially recruited with an average age of 56.64 ± 13.88 years. Patients in the Conbercept and Conbercept + DEX groups gained an average of 14.55 ± 19.19 and 14.88 ± 17.68 ETDRS letters, respectively, at months 12 (t = 4.221, P = 0.000; and t = 4.834, P = 0.000) with no significant difference between the two groups (t = 0.071, P = 0.943). In the Conbercept group, the mean reduction in CRT from baseline to month 12 was 435.26 ± 293.37 μm (t = 8.261, P = 0.000) compared to 431.36 ± 294.55 (t = 8.413, P = 0.000) in the Conbercept + DEX group. There was no significant difference between the two groups (t = 0.053, P = 0.958). The Conbercept + DEX group received fewer intravitreal injections. No major complications occurred.

Conclusion

Conbercept, alone or with DEX, can improve BCVA and reduce CRT in ME following CRVO without serious adverse events. The treatment interval was longer in the Conbercept + DEX group.

Trial Registration

The study was registered with the Chinese Clinical Trial Registry at 5 July 2017. (http://www.chictr.org.cn, 05/07/2017 Registration Number: ChiCTR-INR-17011877).

Comparison of clinical effectiveness of conbercept and ranibizumab for treating retinopathy of prematurity: a meta-analysis

BACKGOUND

Conbercept and ranibizumab have been used to treat retinopathy of prematurity (ROP). However, the clinical effectiveness of conbercept and ranibizumab remains controversial.

AIM

This meta-analysis aimed to compare the effectiveness of conbercept and ranibizumab for treating ROP.

METHOD

We systematically searched Pubmed, Web of Science, Embase, the Cochrane Library, Ovid, Scopus, China National Knowledge Infrastructure, Wanfang Database, CQVIP, Duxiu Database, SinoMed, and X-MOL to screen relevant studies up to November 2022. Retrospective cohort studies and randomized controlled trials (RCTs) evaluating the effectiveness of conbercept and ranibizumab in treating patients with ROP were selected. The outcomes assessed were the rates of primary cure, ROP recurrence, and retreatment. Statistical analysis was performed using Stata.

RESULTS

Seven studies (n = 989) were selected in the meta-analysis. There were 303 cases (594 eyes) treated with conbercept and 686 patients (1,318 eyes) treated with ranibizumab. Three studies reported the primary cure rate. Compared to ranibizumab, conbercept had a significantly higher primary cure rate (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.05-3.49, P < 0.05). Five studies reported the rate of ROP recurrence, and there were no significant differences between conbercept and ranibizumab (OR 0.62, 95% CI 0.28-1.38, P > 0.05). Three studies reported the rate of retreatment, and the rates were not significantly different between conbercept and ranibizumab (OR 0.78, 95% CI 0.21-2.93, P > 0.05).

CONCLUSION

Conbercept had a higher rate of primary cure in ROP patients. More RCTs are needed to compare the efficacy of conbercept and ranibizumab in treating ROP.

Predicting OCT images of short-term response to anti-VEGF treatment for retinal vein occlusion using generative adversarial network

To generate and evaluate post-therapeutic optical coherence tomography (OCT) images based on pre-therapeutic images with generative adversarial network (GAN) to predict the short-term response of patients with retinal vein occlusion (RVO) to anti-vascular endothelial growth factor (anti-VEGF) therapy. Real-world imaging data were retrospectively collected from 1 May 2017, to 1 June 2021. A total of 515 pairs of pre-and post-therapeutic OCT images of patients with RVO were included in the training set, while 68 pre-and post-therapeutic OCT images were included in the validation set. A pix2pixHD method was adopted to predict post-therapeutic OCT images in RVO patients after anti-VEGF therapy. The quality and similarity of synthetic OCT images were evaluated by screening and evaluation experiments. We quantitatively and qualitatively assessed the prognostic accuracy of the synthetic post-therapeutic OCT images. The post-therapeutic OCT images generated by the pix2pixHD algorithm were comparable to the actual images in edema resorption response. Retinal specialists found most synthetic images (62/68) difficult to differentiate from the real ones. The mean absolute error (MAE) of the central macular thickness (CMT) between the synthetic and real OCT images was 26.33 ± 15.81 μm. There was no statistical difference in CMT between the synthetic and the real images. In this retrospective study, the application of the pix2pixHD algorithm objectively predicted the short-term response of each patient to anti-VEGF therapy based on OCT images with high accuracy, suggestive of its clinical value, especially for screening patients with relatively poor prognosis and potentially guiding clinical treatment. Importantly, our artificial intelligence-based prediction approach’s non-invasiveness, repeatability, and cost-effectiveness can improve compliance and follow-up management of this patient population.

Two-Week Central Macular Thickness Reduction Rate >37% Predicts the Long-Term Efficacy of Anti-vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Retinal Vein Occlusion

Objective

To determine if the early response assessments can predict the long-term efficacy of anti-vascular endothelial growth factor (VEGF) treatment for macular edema secondary to retinal vein occlusion (RVO-ME).

Methods

A retrospective study of patients with diagnosis of RVO-ME and intravitreal anti-VEGF treatment was conducted. Clinical characteristics including age, gender, disease subtype and disease duration were recorded at baseline. The best corrected visual acuity (BCVA and logMAR), intraocular pressure (IOP), and central macular thickness (CMT) were recorded at baseline, 2 weeks, and every month (months 1–6) after injection. Further, we compared the early response assessments between the cured group (6-month CMT ≤ 250 μm) and the uncured group (6-month CMT &gt; 250 μm).

Results

A total of 164 eyes in 164 patients (77 male and 87 female) were included. At each post-injection time point, both BCVA and CMT are significantly decreased from baseline (all P &lt; 0.001). Spearman’s test showed that 2-week CMT reduction rate after the first injection was negatively correlated with BCVA at 6 months (r = −0.359, P &lt; 0.001). Compared with the uncured group (47 cases), the cured group (117 cases) was younger (59.53 ± 11.68 vs. 65.19 ± 13.10 years old, P &lt; 0.01), had more BRVO patients (76.1% vs. 44.7%, P &lt; 0.01), a shorter disease duration (1.92 ± 2.43 vs. 5.05 ± 4.32 months, P &lt; 0.01), lower baseline CMT (527.09 ± 154.95 vs. 768.96 ± 287.75 μm, P &lt; 0.01), and lower baseline BCVA (0.86 ± 0.44 vs. 1.31 ± 0.51, P &lt; 0.01). At each post-injection time point, the cured group had lower CMT and BCVA values when compared to the uncured group (all P &lt; 0.01), and the 2-week CMT reduction rate was identified as the earliest response time to predict the long-term treatment efficacy. Moreover, ROC curve analysis indicated that a 2-week CMT reduction rate &gt;37% yielded the best cut-off point for predicting the long-term cure of anti-VEGF treatment at 6 months (P &lt; 0.001). Multivariable logistic regression confirmed that the 2-week CMT reduction rate &gt;37% was independently associated with the 6-month cured rate (OR = 9.639, 95% Cl = 1.030–90.227, P = 0.047).

Conclusion

Age, disease duration, baseline CMT, and baseline BCVA are associated with visual outcomes at 6-month of anti-VEGF treatment for RVO-ME. The “2-week CMT reduction rate &gt;37%” after the first injection is an independent factor to predict better long-term outcomes.

Retinal vein occlusion: drug targets and therapeutic implications

INTRODUCTION

The pathogenesis of retinal vein occlusion (RVO) is extremely complex and includes several mediators. These mediators represent potential drug targets that can be used in the development of intravitreal drugs.

AREAS COVERED

PubMed/MEDLINE databases were accessed between April-May 2021 to find the most relevant scientific papers regarding drug targets and therapeutic implications in RVO, focusing on current therapeutic options and potential cornerstones of future advances in treatment.

EXPERT OPINION

Before the introduction of intravitreal therapies, the visual outcome following a diagnosis of RVO was extremely poor. Anti-VEGF and corticosteroid treatments have radically changed RVO prognosis, helping to preserve patients' visual function and their quality of life. According to current clinical data, anti-VEGF and corticosteroid drugs are associated with both pros and cons; the present recommendation is to employ anti-VEGF molecules as a first-line treatment. Advances in our understanding of the biomolecular characteristics of RVO offer a solid basis for the development of new therapeutic targets and treatments.

Treatment of Macular Edema in Vascular Retinal Diseases: A 2021 Update

Macular edema (ME) is associated with various conditions; however, the main causes of ME are retinal vein occlusion (RVO) and diabetes. Laser photocoagulation, formerly the gold standard for the treatment of ME, has been replaced by anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections. Despite its efficiency, this treatment requires frequent injections to preserve the outcomes of anti-VEGF therapy, and as many patients do not sufficiently respond to the treatment, ME is typically a chronic condition that can lead to permanent visual impairment. Generalized recommendations for the treatment of ME are lacking, which highlights the importance of reviewing treatment approaches, including recent anti-VEGFs, intravitreal steroid implants, and subthreshold micropulse lasers. We reviewed relevant studies, emphasizing the articles published between 2019 and 2021 and using the following keywords: macular edema, diabetic macular edema, retinal vein occlusion, laser photocoagulation, anti-VEGF, and intravitreal injections. Our results revealed that a combination of different treatment methods may be beneficial in resistant cases. Additionally, artificial intelligence (AI) is likely to help select the best treatment option for patients in the near future.

Comparison of the Effect of Intravitreal Conbercept and Ranibizumab on Aqueous Humor Cytokines in Central Retinal Vein Occlusion-Related Macular Edema

Purpose: To analyze changes in the levels of angiogenic and inflammatory cytokines following the administration of intravitreal conbercept (IVC) or intravitreal ranibizumab (IVR) in patients with macular edema (ME) due to central retinal vein occlusion (CRVO). Methods: This retrospective study was conducted between June 2015 and January 2016 in The First Hospital of China Medical University. We administered 3 consecutive monthly doses of IVC (23 eyes) or IVR (19 eyes) in 42 eyes with CRVO-ME. At each injection, we collected aqueous humor samples and used multiplex bead assays to measure 7 angiogenic and inflammatory cytokines [vascular endothelial growth factor (VEGF), placental growth factor (PlGF), platelet-derived growth factor (PDGF)-AA, monocyte chemoattractant protein (MCP)-1, and interleukins (ILs)-6, 8, and 12]. Results: Visual acuity and ME improved significantly in both groups during the treatment period. Compared with the baseline, all the cytokine concentrations in the aqueous humor samples decreased significantly at 1 and 2 months after the initial dose of IVC or IVR. The improvement of visual acuity and ME and the changes of aqueous humor cytokine levels were similar in both groups. Concentrations of VEGF, PlGF, MCP-1, PDGF-AA, IL-6, IL-8, and IL-12 levels did not show significant intergroup differences after 1 month (P = 0.369, 0.312, 0.185, 0.353, 0.135, 0.487, and 0.337, respectively) and 2 months (P = 0.305, 0.376, 0.230, 0.519, 0.114, 0.960, and 0.830, respectively) of follow-up. Conclusion: IVC and IVR induced comparable improvements in clinical parameters, along with equivalent reductions in the concentrations of angiogenic and inflammatory cytokines in the aqueous humor.