不同干预措施治疗息肉样脉络膜血管病变的息肉消退率和治疗预后：系统评价和荟萃分析。

The polyp regression rate and treatment prognosis of different interventions for polypoidal choroidal vasculopathy: a systematic review and meta-analysis.

机构信息

Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.

Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

出版信息

Graefes Arch Clin Exp Ophthalmol. 2021 Apr;259(4):855-872. doi: 10.1007/s00417-020-04977-1. Epub 2020 Oct 29.

DOI:10.1007/s00417-020-04977-1

PMID:33119802

Abstract

PURPOSE

To estimate the polyp regression rate and treatment prognosis of different interventions for polypoidal choroidal vasculopathy (PCV) and clarify its baseline characteristics.

METHODS

The PubMed, EMBASE, and Ovid were searched up to January 2020 to identify related studies. R software version 3.6.3 was used to perform the statistical analyses. Results in proportion with 95% confidence interval (CI) were calculated by means of the Freeman-Tukey variant of arcsine square transformation. Chi-squared test and I statistics were used to evaluate the statistical heterogeneity. Sensitivity analysis and subgroup analyses were performed to identify the source of heterogeneity.

RESULTS

This meta-analysis included 104 studies with 5816 patients. The pooling results indicated the general rate of complete polyp regression at post-treatment 12 months was 64% (95% CI [57~~71%]), 89% (95% CI [81~~95%]) for photodynamic therapy (PDT) monotherapy, 78% (95% CI [68~~86%]) for PDT plus anti-vascular endothelial growth factor (anti-VEGF), and 42% (95% CI [35~~49%]) for anti-VEGF monotherapy; PDT plus anti-VEGF showed the best efficacy in visual improvement and achieved the highest rate of dry macula (91%, 95% CI [78~~99%]), while anti-VEGF monotherapy achieved the lowest polyp recurrence rate (14%, 95% CI [8~~20%]); PDT monotherapy showed the best efficacy in pigment epithelial detachment regression (66%, 95% CI [58~83%]). Additionally, the baseline characteristics of PCV were also well described.

CONCLUSION

PDT plus anti-VEGF is still valuable for the management of PCV; it could achieve not only satisfactory anatomical outcomes like dry macula rate and polyp regression rate but also ideal visual prognosis like BCVA improvement.

摘要

目的

评估不同干预措施治疗息肉样脉络膜血管病变（PCV）的息肉消退率和治疗预后，并阐明其基线特征。

方法

检索PubMed、EMBASE 和 Ovid 数据库，查找截至 2020 年 1 月的相关研究。使用 R 软件版本 3.6.3 进行统计分析。采用 Freeman-Tukey 变体反正弦平方变换计算比例结果及其 95%置信区间（CI）。采用卡方检验和 I 统计量评估统计异质性。进行敏感性分析和亚组分析以确定异质性来源。

结果

本荟萃分析纳入了 104 项研究，共 5816 例患者。汇总结果表明，治疗后 12 个月完全息肉消退的总体率为 64%（95%CI[57%~~71%]），单纯光动力疗法（PDT）治疗为 89%（95%CI[81%~~95%]），PDT 联合抗血管内皮生长因子（anti-VEGF）治疗为 78%（95%CI[68%~~86%]），单纯抗 VEGF 治疗为 42%（95%CI[35%~~49%]）；PDT 联合抗 VEGF 治疗在改善视力方面效果最好，达到了最高的干性黄斑发生率（91%，95%CI[78%~~99%]），而抗 VEGF 单药治疗的息肉复发率最低（14%，95%CI[8%~~20%]）；单纯 PDT 治疗在色素上皮脱离消退方面效果最好（66%，95%CI[58%~83%]）。此外，还很好地描述了 PCV 的基线特征。