For a study, researchers sought to determine how anti-vascular endothelial growth factor (VEGF) medication affected intraocular pressure (IOP) 12 and 24 months after it was started. Anti-VEGF drugs were compared to each other or to controls in randomized controlled trials (RCTs) to treat neovascular age-related macular degeneration, retinal vein occlusions, or diabetic macular edema. The proportion of patients whose IOP increased 5 mmHg or more from baseline on consecutive visits, increased 10 mmHg or more from baseline at any visit, was 21 mmHg or more on consecutive visits, was 25 mmHg or more at any visit, was 30 mmHg or more at any visit, prompted initiation of IOP-lowering medications, or increased as per the clinicians’ discretion was investigated using pairwise meta-analysis and Bayesian network meta-analysis. Recommendation Evaluation The approach used in the Assessments, Development, and Evaluations shaped the evidence’s certainty. There were 26 RCTs with a total of 12,522 eyes. Investigators looked at aflibercept, bevacizumab, ranibizumab (0.3 mg and 0.5 mg), and non-injection controls. About 83 out of 84 network estimations for anti-VEGF drug comparisons showed no statistically significant difference (low to moderate certainty of the evidence). At 12 months, intravitreal ranibizumab 0.5 mg had a greater rate of IOP readings of 30 mmHg or more than bevacizumab (low certainty of the evidence). There was no statistically significant difference between anti-VEGF drugs and controls in 53 out of 56 network estimations (low to moderate certainty of the evidence). At 24 months, ranibizumab 0.5 mg revealed greater rates of consecutive IOP rises of 5 mmHg or more (poor confidence of evidence) and higher rates of IOP increases at the discretion of the doctors at 12 and 24 months (low certainty of the evidence) (low and very low certainty of the evidence, respectively). In comparisons with no statistically significant effects, the 95% credible intervals did not rule out substantial clinical effects. Imprecision limits the confidence of evidence in these comparisons.
Reference:www.aaojournal.org/article/S0161-6420(21)00917-9/fulltext
