Intravitreal injection of anti-vascular endothelial growth factor combined with photodynamic therapy or photodynamic therapy only for polypoidal choroidal vasculopathy: a systematic review

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Author:
SHEN Chao-lan(State Key Laboratory of Ophthalmology ,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China)
LI Chu(State Key Laboratory of Ophthalmology ,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China)
XIA Ren-chun(State Key Laboratory of Ophthalmology ,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China)
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Journal Title:
Chinese Journal of Ocular Fundus Diseases
Issue:
Volume 28, Issue 05, 2012
DOI:
10.3760/cma.j.issn.1005-1015.2012.05.018
Key Word:
Choroid diseases/therapy; Antibodies, monoclonal/therapeutic use;Photochemotherapy; Meta-analysis

Abstract: Objective To evaluate the efficacy and safety of intravitreal anti-vascular endothelial growth factor (VEGF) combined with photodynamic therapy (PDT) vs.photodynamic therapy for polypoidal choroidal vasculopathy (PCV).Methods A computerized search was conducted in Pubmed,OVID,Chinese Biological Medicine Database(CBM),China National Knowledge Infrastructure (CNKI) by using key words “polypoidal choroidal vasculopathy,photodynamic therapy,intravitreal anti VEGF” in Chinese and/or English combined with manually searching of bibliographies of pertinent articles,journals and literature reference proceedings.Randomized controlled trials (RCT) and non-RCT were collected.The search time was ranged from establishment of each database to September,2011.The search was no limitation in language.The best corrected visual acuity (BCVA),resolution and recurring of lesions,decrease or complete resolution of pigment epithelial detachment (PED),visual extinction or blindness rate,the rate of subretinal hemorrhage were analyzed by RevMan 5.0 software.Results In total,one RCT and four non-RCTs (273 patients) were included in the meta-analysis involving 148 patients in single treatment group and 125 patients in combined treatment group.The results of meta-analyses showed that there was no significant difference between two groups in the mean logarithm of minimal angle of resolution BCVA at six months [standard mean difference=0.01,95% confidence interval (CI):-0.12-0.14,P=0.84] and 12 months [standard mean difference =0.04,95% CI:-0.16-0.25,P=0.69] after treatment.There was no significant difference between two groups in the resolution of lesions [odds ratio (OR)=1.38,95 % CI:0.74-2.55,P=0.31] at the months after treatment and decrease or complete resolution of PED (OR=0.67,95% CI:0.12-3.69,P=0.65) at 12 months after treatment.There was no significant difference between two groups in the recurring of lesions (OR=1.14,95% CI:0.58-2.24,P=0.71) and lost of ≥three lines vision or blindness rate (OR=1.20,95% CI:0.34-4.18,P= 0.78) at 12 months after treatment.The rate of subretinal hemorrhage in combine treatment group was significant lower than single treatment group (OR=0.41,95% CI:0.18-0.94,P=0.04).Conclusions The incidence of subretinal hemorrhage occurred in patients with PCV after intravitreal anti-VEGF combined with PDT is much lower than that after single PDT.But the visual improvement,resolution of lesions and recurring of lesions of combined treatment need further studied to see if it is better than single PDT.

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