Purpose

To review the evidence on the safety and efficacy of anti-vascular endothelial growth factor (VEGF) therapies for the treatment of neovascular age-related macular degeneration (AMD).

Methods

A literature search of the PubMed and Cochrane Library databases was last conducted in February 2017; there were no date restrictions, and the search was limited to studies published in English. The combined searches yielded 191 citations, 28 of which were selected because they were clinical trials and were deemed clinically relevant for the Ophthalmic Technology Assessment Committee Retina/Vitreous Panel to review in full. The panel methodologist then assigned a level of evidence rating to each study.

Results

Sixteen of the 28 citations provided level I evidence supporting the use of anti-VEGF agents for neovascular AMD, including intravitreal ranibizumab, aflibercept, and bevacizumab. Eight studies reviewed provided level II evidence, and 4 studies provided level III evidence, but only the level I studies are included in this assessment. There are long-term follow-up data on the efficacy of ranibizumab and bevacizumab (≥5 years), but these data are subject to the bias of incomplete follow-up.

Conclusions

Review of the literature indicates that intravitreal injection of anti-VEGF therapy is safe and effective for neovascular AMD over 2 years, the period for which data are available. Further research is needed to evaluate the long-term safety and comparative efficacy of these agents.

中文翻译：

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抗血管内皮生长因子治疗新血管性年龄相关性黄斑变性的安全性和有效性

目的

审查有关抗血管内皮生长因子（VEGF）治疗新血管性年龄相关性黄斑变性（AMD）的安全性和有效性的证据。

方法

2017年2月对PubMed和Cochrane图书馆数据库进行了文献检索; 没有日期限制，并且搜索仅限于以英语发表的研究。合并检索产生191篇引文，之所以选择其中28篇，是因为它们是临床试验，被认为与眼科技术评估委员会视网膜/玻璃体专家小组进行全面临床审查有关。然后，小组方法学家为每个研究指定了证据等级。

结果

在28次引用中，有16次提供了I级证据，支持将抗VEGF药物用于新生血管AMD，包括玻璃体内兰尼单抗，阿柏西普和贝伐单抗。审查的八项研究提供了II级证据，而4项研究提供了III级证据，但只有I级研究被包括在该评估中。有关于兰尼单抗和贝伐单抗疗效的长期随访数据（≥5年），但这些数据受随访不完全的影响。

结论

文献综述表明，玻璃体内注射抗VEGF治疗对于2年来可获得数据的新生血管AMD是安全有效的。需要进一步的研究来评估这些药物的长期安全性和比较疗效。