Photodynamic therapy versus anti-vascular endothelial growth factor agents for polypoidal choroidal vasculopathy: A meta-analysis

Abstract

BackgroundThe aim of this study was to evaluate the efficacy and tolerability of photodynamic therapy (PDT) compared to intravitreal vascular endothelial growth factor (VEGF) inhibitors in the treatment of polypoidal choroidal vasculopathy (PCV).MethodsRelevant studies were selected through an extensive search of the PubMed, EMBASE, Web of Science, and Cochrane Library databases. Outcomes of interest included visual outcomes, anatomic variables, and adverse events.ResultsSix studies enrolling a total of 346 patients were included. The weighted mean differences (WMDs) of the mean changes in LogMAR VA when comparing PDT with anti-VEGF were −0.02 (95 % confidence interval [CI]: −0.12–0.08) at 3 months, 0.02 (95 % CI: −0.12–0.16) at 6 months, 0.02 (95 % CI: −0.15–0.18) at 12 months, and −0.17 (95 % CI: −0.90–0.55) at 24 months. There were no significant differences between the two groups at any of the time points. PDT was found to be associated with greater reduction of central retinal thickness (CRT) at six months (WMD: 44.94; 95 % CI: 16.44–73.44; P = 0.002), and it was superior to anti-VEGF therapy in achieving complete polyp regression (odd ratio, OR: 6.85; 95 % CI: 2.15–21.79; P = 0.001).Rates of adverse events did not differ significantly between the two treatments.ConclusionsPDT appeared to result in greater CRT reduction at six months and higher polyp regression rate. However, the two treatments appear to be comparable in terms of best corrected visual acuity change and adverse events.

The Finnish national guideline for diagnosis, treatment and follow‐up of patients with wet age‐related macular degeneration

“…; Yong et al. ). When combined, PDT reduces the need for intravitreal anti‐VEGF injections (Koh et al.…”

Polypoidal choroidal vasculopathy treatment options: A meta‐analysis

“…25,27,32 As for intravitreal anti-VEGF injections, the rapid resolution of exudative fluid and retinal oedema can play an important role in ensuring favourable BCVA outcomes. 10 In this meta-analysis, combined therapy utilising PDT and anti-VEGF was superior to PDT in improving BCVA at all follow-up points, suggesting that anti-VEGF may overcome the deficiencies of PDT monotherapy with regard to this aspect. Furthermore, BCVA improvements seemed to decrease with time in the PDT monotherapy group, suggesting that additional PDT may be necessary to sustain these improvements.…”

“…Some studies have reported that PDT was superior to anti‐VEGF therapy in terms of polyp regression . As for intravitreal anti‐VEGF injections, the rapid resolution of exudative fluid and retinal oedema can play an important role in ensuring favourable BCVA outcomes …”

Comparison of the 12-Month Outcomes of Intravitreal Ranibizumab between Two Angiographic Subtypes of Polypoidal Choroidal Vasculopathy

“…Previous reports have demonstrated that PCV showed a good visual outcome with IVR [6,7,18] , but it is also known that certain PCV cases exhibited poor response to IVR [10,19] although the reasons were unknown. In the present study, type 1 PCV classified by the presence of clear BVN with polypoidal lesions showed a good visual outcome of IVR, but type 2 PCV did not show any improvement in mean BCVA.…”