Abstract
PurposeThe aim of this study was to evaluate the efficacy and safety of photodynamic therapy (PDT) combined with intravitreal vascular endothelial growth factor (VEGF) inhibitors compared to those of PDT alone in the treatment of polypoidal choroidal vasculopathy (PCV).MethodsA systematic search of Pubmed, Embase, and the Cochrane Library was performed to identify all comparative studies that compared the outcomes of the two approaches. Outcomes of interest included visual outcomes, anatomic variables, and adverse events.ResultsTwo randomised controlled trials and nine retrospective studies including a total of 543 cases were identified. At three and six months post-injection, no significant difference in visual acuity was found in the combined therapy group compared with the PDT monotherapy group, with pooled weighted mean differences (WMDs) of 0.074 (−0.021, 0.17) at three months and 0.082 (−0.013, 0.18) at six months. However, the mean changes in visual acuity at month 12 in the combined therapy group were significantly better than those in the PDT monotherapy group, with pooled WMDs of 0.11 (0.012, 0.21). Similar efficacy was found at 24 months (WMD: 0.21; 95%CI: 0.054, 0.36; P = 0.008). Patients in the combined therapy group also might benefit from reduced retinal haemorrhage (OR: 0.32; 95% CI: 0.14, 0.74; P = 0.008). Polyp regression, recurrence of PCV, central retinal thickness reduction, and pigment epithelial detachment resolution did not differ significantly between the two treatments.ConclusionsCombined treatment appeared to result in better visual acuity and lower retinal haemorrhage. However, combined treatment did not affect the resolution and recurrence of lesions. Given the inherent limitations of the included studies, future well-designed RCTs are awaited to confirm and update the findings of this analysis.
Highlights
Polypoidal choroidal vasculopathy (PCV) is a sight-threatening disease, which is relatively prevalent in Asian populations [1]
photodynamic therapy (PDT) is widely used in the treatment of PCV, as various studies have demonstrated that PDT can result in visual improvement [4,5,6,7]
Similar efficacy was found at 24 months (WMD: 0.21; 95%confidence intervals (CIs): 0.054, 0.36; p = 0.008)
Summary
Polypoidal choroidal vasculopathy (PCV) is a sight-threatening disease, which is relatively prevalent in Asian populations [1]. PDT is widely used in the treatment of PCV, as various studies have demonstrated that PDT can result in visual improvement [4,5,6,7]. With the introduction of anti-VEGF drugs in ophthalmology community, intravitreal anti-VEGF agents were widely used for neovascular disease such as wet age related macular degeneration and PCV. Unlike for age related macular degeneration, anti-VEGF compounds by themselves do not work well in PCV. Combination therapy comprising PDT and anti-VEGF drugs, such as bevacizumab and ranibizumab, become another treatment choice for PCV. Because increased expression of VEGF has been found in PCV patients following PDT, the combined therapy has been thought to result in additional or complementary effects [2]
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