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Photodynamic therapy versus anti-vascular endothelial growth factor agents for polypoidal choroidal vasculopathy: a meta-analysis.

ABSTRACT: The aim of this study was to evaluate the efficacy and tolerability of photodynamic therapy (PDT) compared to intravitreal vascular endothelial growth factor (VEGF) inhibitors in the treatment of polypoidal choroidal vasculopathy (PCV).Relevant studies were selected through an extensive search of the PubMed, EMBASE, Web of Science, and Cochrane Library databases. Outcomes of interest included visual outcomes, anatomic variables, and adverse events.Six studies enrolling a total of 346 patients were included. The weighted mean differences (WMDs) of the mean changes in LogMAR VA when comparing PDT with anti-VEGF were -0.02 (95 % confidence interval [CI]: -0.12-0.08) at 3 months, 0.02 (95 % CI: -0.12-0.16) at 6 months, 0.02 (95 % CI: -0.15-0.18) at 12 months, and -0.17 (95 % CI: -0.90-0.55) at 24 months. There were no significant differences between the two groups at any of the time points. PDT was found to be associated with greater reduction of central retinal thickness (CRT) at six months (WMD: 44.94; 95 % CI: 16.44-73.44; P?=?0.002), and it was superior to anti-VEGF therapy in achieving complete polyp regression (odd ratio, OR: 6.85; 95 % CI: 2.15-21.79; P?=?0.001).Rates of adverse events did not differ significantly between the two treatments.PDT appeared to result in greater CRT reduction at six months and higher polyp regression rate. However, the two treatments appear to be comparable in terms of best corrected visual acuity change and adverse events.

SUBMITTER: Yong M

PROVIDER: S-EPMC4513969 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Photodynamic therapy versus anti-vascular endothelial growth factor agents for polypoidal choroidal vasculopathy: a meta-analysis.

Yong Meng M Zhou Minwen M Deng Guohua G

BMC ophthalmology 20150725

<h4>Background</h4>The aim of this study was to evaluate the efficacy and tolerability of photodynamic therapy (PDT) compared to intravitreal vascular endothelial growth factor (VEGF) inhibitors in the treatment of polypoidal choroidal vasculopathy (PCV).<h4>Methods</h4>Relevant studies were selected through an extensive search of the PubMed, EMBASE, Web of Science, and Cochrane Library databases. Outcomes of interest included visual outcomes, anatomic variables, and adverse events.<h4>Results</ ...[more]

PMID: 26209516

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Project description:ImportanceCD11b+ immune cells have been implicated in the formation of choroidal neovascularization in experimental studies on animals and disease-association studies on humans. However, the clinical importance of such observations remains unknown.ObjectiveTo investigate whether the proportion of CD11b+ circulating monocytes is associated with the number of anti-vascular endothelial growth factor (anti-VEGF) injections in neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV).Design, setting, and participantsThese observational cohort studies collected data from January 1, 2010, through December 31, 2013, and from January 1, 2015, through December 31, 2018. Fresh venous blood samples were acquired for flow cytometric immune studies in patients with neovascular AMD or PCV receiving treatment with aflibercept or ranibizumab as needed for 36 months. Patients (n = 81) without immune diseases were consecutively recruited from a single center in Denmark.ExposuresProportion of CD11b+ circulating monocytes.Main outcomes and measuresThe estimation of the number of intravitreal anti-VEGF injections given at 12, 24, and 36 months by the proportion of CD11b+ circulating monocytes and the correlation between these values. The angiogenic role of CD11b+ circulating monocytes was further evaluated by investigating the expression of the known proangiogenic receptor CCR2.ResultsEighty-one patients were included in the analysis (54% women; mean [SD] age, 76 [7] years). The proportion of CD11b+ monocytes at baseline positively estimated the future number of anti-VEGF injections at 12 (ρ = 0.77; 95% CI, 0.35-0.93; P = .004), 24 (ρ = 0.82; 95% CI, 0.44-0.95; P = .002), and 36 (ρ = 0.78; 95% CI, 0.34-0.94; P = .005) months. This association was also found retrospectively in a larger sample of patients with neovascular AMD at 12 (ρ = 0.46; 95% CI, 0.16-0.68; P = .004), 24 (ρ = 0.49; 95% CI, 0.20-0.70; P = .002), and 36 (ρ = 0.65; 95% CI, 0.41-0.80; P < .001) months and patients with PCV at 12 (ρ = 0.27; 95% CI, -0.28 to 0.68; P = .30), 24 (ρ = 0.60; 95% CI, 0.12-0.85; P = .02), and 36 (ρ = 0.70; 95% CI, 0.27-0.90; P = .005) months, suggesting that this association is not specific to AMD but rather reflects VEGF activity in neovascularization. CD11b+ monocytes highly coexpressed CCR2, an important monocytic marker of proangiogenic activity.Conclusions and relevanceResults of this study demonstrated that the proportion of circulating CD11b+ monocytes estimated and correlated with the number of anti-VEGF injections in patients with neovascular AMD and PCV. Additional longitudinal studies are needed to determine whether these findings have clinical relevance to influence treatment algorithms or provide novel targets for medical therapy.

Dataset Information

Photodynamic therapy versus anti-vascular endothelial growth factor agents for polypoidal choroidal vasculopathy: a meta-analysis.

Publications

Photodynamic therapy versus anti-vascular endothelial growth factor agents for polypoidal choroidal vasculopathy: a meta-analysis.

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