| Objective:Meta-analysis was performed to compare the clinical efficacy of Photodynamic therapy(PDT),intravitreal injection of anti-vascular endothelial growth factor(VEGF),and combined therapy in the treatment of(Polypoidal choroidal vasculopathy,PCV).The aim is to provide evidence-based medical evidence for clinicians’ choice of treatment for PCV.Methods:The data of efficacy comparison of PDT alone therapy,anti-VEGF alone therapy and combination therapy were comprehensively retrieved in Pub Med,Embase and Cochrane databases.The limited publication time of searching is from the establishment of the database to October 12,2020.After the retrieval,the literatures were filtered according to the established inclusion and exclusion criteria and then the quality of these literatures were evaluted.Then,relevant outcome indicators in the enrolled studies were extracted and the results were obtained by statistical analysis.The evaluating indicator of this study including the Best corrected visual acuity(BCVA),Central retinal thickness(CRT),the proportion of complete regression of polyps,and the incidence rate of ocular adverse events(subretinal hemorrhage and vitreous hemorrhage)after treatment.The statistical software Rev Man5.4 provided by Cochrane Collaboration was used to process the data,and the Mean differences(MD),Odds ratio(OR)and 95% Confidence interval(CI)of the results of each evaluating indicator were combined and calculated for meta-analysis.Results:Twenty-five studies(5 randomized controlled trials,19 retrospective studies,and1 prospective cohort study)involved 1883 patients with PCV were enrolled in this study.Results of Meta-analysis showed that: 1.Comparison between the anti-VEGF monotherapy group and the PDT monotherapy group: In terms of visual acuity improvement,there was no significant difference in BCVA between the anti-VEGF monotherapy group and the PDT monotherapy group at 3 months,6 months,12 months and 24 months(P= 0.88,0.68,0.92,0.75,respectively,>0.05).In terms of CRT reduction,there was no significant difference in CRT reduction between anti-VEGF monotherapy group and PDT monotherapy group 3 months,6 months,12 months and 24 months(P = 0.58,0.65,0.35,0.50,respectively >0.05).In terms of polyp regression,the rates of polyp regression were significantly different between the anti-VEGF monotherapy group and the PDT monotherapy group at 3 months and more than 6 months,with MD(95%CI)of 0.14[0.07,0.29] and 0.21[0.11,0.37],respectively,P <0.00001,indicating that the PDT monotherapy group was superior to the anti-VEGF monotherapy group.In terms of ocular adverse events,the incidence of ocular adverse events in the anti-VEGF monotherapy group was lower than that in the PDT monotherapy group,and the difference was statistically significant(OR(95%CI)=0.19 [0.06,0.62],P=0.006<0.05).2.PDT monotherapy group and combined treatment group comparison results: In terms of visual acuity improvement:There was significantly difference between PDT monotherapy group and combined treatment group at 3 months,6 months and 24 months,(MD(95% CI)=0.08(0.01,0.15),0.08(0.01,0.15],0.26 [0.14,0.38],P =0.02,0.03,respectively,< 0.05).The results showed that the mean BCVA Log MAR value of PDT monotherapy group was higher than that for combined treatment group at each follow-up time point.However,the lower Log MAR value means the better BCVA.Therefore,the results showed that the BCVA of combined treatment group was better than PDT monotherapy group at 3,6 and 24 months.However,the combined statistical results indicate that BCVA in the combined treatment group was better than that for PDT monotherapy group at 12 months,but the difference was not statistically significant.In terms of CRT reduction,there was no significant difference in CRT between PDT monotherapy group and combined group at 3,6,12 and 24 months(P=0.14,0.25,0.73,0.65,respectively,>0.05).In terms of polyp regression,there was no significant difference in the rate of polyp regression between PDT monotherapy group and combined treatment group at 3 months and over 6 months(P= 0.27,0.55,respectively,>0.05).In terms of ocular adverse events,there was a significant difference between PDT monotherapy group and combined treatment group during the follow-up period,and the difference was statistically significant(OR(95%CI)=2.25 [1.30,3.91],P=0.004<0.05).This suggested that PDT monotherapy group had a higher incidence of ocular adverse events.3.Anti VEGF monotherapy group and combined treatment group comparison results: In terms of visual acuity improvement: there was no significant difference in BCVA between anti VEGF monotherapy group and combination therapy group at 3 months,6 months(P=0.97,0.49,respectively,> 0.05).However,there was significant difference in BCVA between anti VEGF monotherapy group and combination therapy group at 12 months and 24 months(MD(95%CI)=0.07 [0.02,0.12] and 0.15 [0.01,0.29],respectively;P =0.005,0.03,respectively,both<0.05),indicating that BCVA in combined treatment group was better than that in the anti-VEGF monotherapy group at 12 months and 24 months.In terms of CRT reduction,there was no significant difference in CRT between anti-VEGF monotherapy group and the combined treatment group at 3,6,12 and 24 months(P =0.36,0.63,0.09,0.16,respectively,>0.05).In terms of polyp regression,there were significant statistical differences in the rate of polyp regression between the anti-VEGF monotherapy group and combination treatment group at 3 months,6months and >6 months(OR(95%CI)0.16 [0.10,0.26],0.17 [0.09,0.32] and 0.22[0.16,0.29],respectively,all P <0.00001).The results showed that the polyp regression rate of the combined treatment group was significantly better than that for anti-VEGF single treatment group at each follow-up time point.In terms of ocular adverse events,there was no statistically significant difference in the incidence of ocular adverse events between the anti-VEGF monotherapy group and combination treatment group during the follow-up period(P=0.56>0.05).Conclusion:(1)There is no significant difference in the improvement of visual acuity between intravitreal anti-VEGF monotherapy and PDT monotherapy for PCV.PDT monotherapy has a higher rate of polyp regression than anti-VEGF monotherapy,and VEGF monotherapy has fewer ocular adverse events than PDT monotherapy.However,neither should be the best choice for PCV treatment.(2)The combination treatment of intravitreal injection of anti-VEGF drugs and PDT is superior to PDT monotherapy in terms of visual improvement both in short-term(3 months,6 months)and in long-term(24 months).There is no significant difference between the two groups in achieving polyp regression.The incidence of ocular adverse events in combination therapy is lower than that in PDT monotherapy,so the safety is higher.(3)There is no significant difference in visual acuity improvement between combination treatment of intravitreal injection of anti-VEGF drugs and PDT and anti-VEGF monotherapy in short-term(3 months,6 months),while the visual acuity improvement in combination treatment group was superior to that for anti-VEGF monotherapy.In addition,combination therapy was superior to anti-VEGF monotherapy in achieving polyp regression.There was no significant difference in the incidence of ocular adverse events between the two groups,both of them are safe treatment.(4)Combination therapy is superior to anti-VEGF monotherapy and PDT monotherapy,so combination therapy seems to be a better choice for PCV treatment. |
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