Polypoidal choroidal vasculopathy treatment options: A meta‐analysis

Abstract

BackgroundCombined treatment with intravitreal anti‐vascular endothelial growth factor (anti‐VEGF) and verteporfin photodynamic therapy (PDT) is widely used for patients with polypoidal choroidal vasculopathy (PCV), although clinical evidence regarding the therapeutic efficacy and safety of such treatment remains lacking.Design/MethodsWe performed a meta‐analysis of previously reported studies comparing combination treatment, PDT monotherapy, and anti‐VEGF monotherapy. Primary outcome measures included changes in best‐corrected visual acuity (BCVA) and central retinal thickness (CRT). The proportion of patients with polyp regression was regarded as the secondary outcome measure.ResultsTwenty studies (three RCTs and 19 retrospective studies) involving 1,178 patients with PCV were selected. Significant differences in the proportion of patients with polyps were observed between the PDT and anti‐VEGF monotherapy groups at 3 and ≥6 months (P < .00001; and P = .0001, respectively). Significantly greater reductions in CRT were observed in the anti‐VEGF than in the PDT group at the 3‐month follow‐up (P = .04). Significantly greater improvements in BCVA were observed in the combined therapy group than in the PDT monotherapy group at 3, 6, 12, and 24 months (P = .03; P = .005; P = .02; and P < .00001, respectively). Combined treatment also resulted in significantly greater improvements in BCVA than monotherapy with anti‐VEGF at 6 and 24 months (P = .001; P < .00001, respectively), and significantly greater polyp regression than that observed following anti‐VEGF treatment at 3 and ≥6 months (P < .00001; P < .0001, respectively).ConclusionsCombined therapy involving anti‐VEGF agents and PDT may be more effective in improving long‐term outcomes for patients with PCV than monotherapy.

Choroidal Neovascularization: Mechanisms of Endothelial Dysfunction

“…These are humanized monoclonal antibodies which act to decrease elevated VEGF at the site of neovascularization, eventually restoring retinal thickness and function (Golbaz et al, 2011). Other interventions for wet AMD include verteporfin photodynamic therapy, which is used in combination with anti-VEGF therapy to stimulate polyp regression in PCV (Cho et al, 2012; Qian et al, 2018). While anti-VEGF therapy has restored vision for many, the monotherapy does not improve visual acuity in a substantial number of AMD patients as a form of long-term management (Rofagha et al, 2013; Fernández-Robredo et al, 2014; Bracha et al, 2017; Dunn et al, 2017; Jaffe et al, 2017; Malek et al, 2018).…”

Polypoidal choroidal vasculopathy: An update on current management and review of literature

“…Two systematic reviews and meta-analysis[214215] suggested that combination of PDT and anti-VEGF therapy had more potential in achieving early and maintaining better long-term visual outcomes than PDT monotherapy. Additional PDT sessions induce SRH and ischemic damage to choroidal tissue, explaining the loss of improvement in VA in the PDT monotherapy.…”

Systematic review with network meta-analysis of antivascular endothelial growth factor use in managing polypoidal choroidal vasculopathy

“…Synthesized evidence from 4 studies was published before 2019 19 – 22 , and the latest meta-analysis derived conclusions from heterogeneous findings due to mixed data from retrospective studies and 2 RCTs. Notably, conceptual heterogeneity is unavoidable Consequently, the appropriate treatment strategy for PCV remains controversial.…”

“…Notably, in early combination therapy, a patient receives PDT and anti-VEGF therapy at the beginning of the treatment course. However, in late combination therapy, patients receive anti-VEGF first, followed by rescue PDT.Synthesized evidence from 4 studies was published before 2019 [19][20][21][22] , and the latest meta-analysis derived conclusions from heterogeneous findings due to mixed data from retrospective studies and 2 RCTs. Notably,…”