[Efficacy evaluation of photodynamic therapy and intravitreal anti-VEGF injection for polypoidal choroidal vasculopathy: systematic review].

OBJECTIVE

To compare the efficacy of photodynamic therapy (PDT) alone, intravitreal anti-vascular endothelial growth factor (VEGF) therapy alone, and the combination of the two therapies for polypoid choroidal vasculopathy (PCV).

METHODS

Systematic review. A computerized search was conducted in Pubmed,Biosis Preview, Cochrane Library, and Embase.Studies comparing any two of the above three treatment strategies were enrolled in the study. Meta-analysis of pairwise comparisons of the three approaches was conducted. The primary endpoint was the proportion of patients with complete regression of polyps.Other endpoints included best corrected visual acuity (BCVA), central retinal thickness (CRT), number of treatments.

RESULTS

A total of 13 comparative studies were obtained, including 1 randomized controlled trials (RCT) and 12 retrospective comparative study (RCS).Four studies compared anti-VEGF monotherapy with PDT monotherapy.Seven studies compared PDT monotherapy with combination therapy.Four studies compared anti-VEGF monotherapy with combination therapy. Considering the RCT and RCS results: PDT was superior to anti-VEGF in achieving complete regression of polyps at month 6 (P = 0.004) , although BCVA and CRT showed no significant difference at 12-month follow-up. There was no significant difference in BCVA, CRT, and the proportion of patients with complete regression of polyps between PDT and combination group at 12 months follow-up.However, combination therapy showed more promising result in improving visual acuity at 24 months (P = 0.05), with fewer PDT needed than in PDT monotherapy. Combination therapy was superior to anti-VEGF in achieving complete regression of polyps and the number of injections needed tended to be fewer. BCVA improvement and CRT reduction showed no significant difference at 12-month follow-up.

CONCLUSION

PDT with or without anti-VEGF therapy is superior to anti-VEGF monotherapy in achieving complete polyp regression, and combination therapy appeared to result in better visual outcome than PDT monotherapy in the long term (2 years).