Enhancing anti-vascular endothelial growth factor with photodynamic therapy for polypoidal choroidal vasculopathy: A meta-analysis

Ting-Han Lin; Hung-Yi Lin; Po-Chen Tseng

doi:10.1016/j.survophthal.2024.12.006

Enhancing anti-vascular endothelial growth factor with photodynamic therapy for polypoidal choroidal vasculopathy: A meta-analysis

Surv Ophthalmol. 2024 Dec 19:S0039-6257(24)00157-7. doi: 10.1016/j.survophthal.2024.12.006. Online ahead of print.

Authors

Ting-Han Lin¹, Hung-Yi Lin², Po-Chen Tseng³

Affiliations

¹ China Medical University Hospital, China Medical University, Taichung, Taiwan.
² National Taichung University of Science and Technology, Taichung City, Taiwan.
³ Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei, Taiwan; Department of Special Education, University of Taipei, Taipei, Taiwan; Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: daf06@tpech.gov.tw.

PMID: 39709034
DOI: 10.1016/j.survophthal.2024.12.006

Abstract

Anti-vascular endothelial growth factor (VEGF) agents administered as either monotherapy or combination with verteporfin photodynamic therapy (PDT) are the 2 dominant treatment for polypoidal choroidal vasculopathy (PCV); However, controversies remain due to small sample sizes and inconsistency in prognosis from randomized controlled trials (RCTs). In accordance with the PRISMA statement, we investigated the efficacy of PDT plus anti-VEGF combination with anti-VEGF monotherapy. This study was accepted by the International Prospective Register of Systematic Reviews (CRD42023471362). Studies published up to July, 2024, were retrieved from PubMed, Embase, and Cochrane databases. A total of 7 RCTs with 926 eyes were reviewed. In 6 trials, combination therapy showed significantly higher rate of complete polyp regression (risk ratio [RR]: 1.56, 95% CI: 1.15-2.13, p = 0.005). In 5 trials, combination therapy also significantly reduced the number of anti-VEGF injections (SMD: -0.65, 95% CI: -0.95 to -0.35, p < 0.0001). For best corrected visual acuity improvement, central retinal thickness reduction, and rate of ocular adverse events, the performance of the 2 modalities were comparable. We conclude that PDT plus anti-VEGF combination therapy constitutes a safe and effective modality and should be considered the first-line treatment for PCV.

Keywords: Age-Related Macular Degeneration; Anti-Vascular Endothelial Growth Factor; Combined Modality Therapy; Photodynamic Therapy; Polypoidal Choroidal Vasculopathy.

Publication types

Review