Skip to main content
Top
Published in: BMC Ophthalmology 1/2015

Open Access 01-12-2015 | Research article

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

Authors: Meng Yong, Minwen Zhou, Guohua Deng

Published in: BMC Ophthalmology | Issue 1/2015

Login to get access

Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.
Literature
1.
go back to reference Yannuzzi LA, Sorenson J, Spaide RF, Lipson B. Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina. 1990;10:1–8.CrossRefPubMed Yannuzzi LA, Sorenson J, Spaide RF, Lipson B. Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina. 1990;10:1–8.CrossRefPubMed
2.
go back to reference Chan WM, Lam DS, Lai TY, Liu DT, Li KK, Yao Y, et al. Photodynamic therapy with verteporfin for symptomatic polypoidal choroidal vasculopathy: one-year results of a prospective case series. Ophthalmology. 2004;111:1576–84.CrossRefPubMed Chan WM, Lam DS, Lai TY, Liu DT, Li KK, Yao Y, et al. Photodynamic therapy with verteporfin for symptomatic polypoidal choroidal vasculopathy: one-year results of a prospective case series. Ophthalmology. 2004;111:1576–84.CrossRefPubMed
3.
go back to reference Bessho H, Honda S, Imai H, Negi A. Natural course and funduscopic findings of polypoidal choroidal vasculopathy in a Japanese population over 1 year of follow-up. Retina. 2011;31:1598–602.CrossRefPubMed Bessho H, Honda S, Imai H, Negi A. Natural course and funduscopic findings of polypoidal choroidal vasculopathy in a Japanese population over 1 year of follow-up. Retina. 2011;31:1598–602.CrossRefPubMed
4.
go back to reference Sho K, Takahashi K, Yamada H, Wada M, Nagai Y, Otsuji T, et al. Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol. 2003;121:1392–6.CrossRefPubMed Sho K, Takahashi K, Yamada H, Wada M, Nagai Y, Otsuji T, et al. Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol. 2003;121:1392–6.CrossRefPubMed
5.
go back to reference Obata R, Yanagi Y, Kami J, Takahashi H, Inoue Y, Tamaki Y. Polypoidal choroidal vasculopathy and retinochoroidal anastomosis in Japanese patients eligible for photodynamic therapy for exudative age-related macular degeneration. Jpn J Ophthalmol. 2006;50:354–60.CrossRefPubMed Obata R, Yanagi Y, Kami J, Takahashi H, Inoue Y, Tamaki Y. Polypoidal choroidal vasculopathy and retinochoroidal anastomosis in Japanese patients eligible for photodynamic therapy for exudative age-related macular degeneration. Jpn J Ophthalmol. 2006;50:354–60.CrossRefPubMed
6.
go back to reference Hou J, Tao Y, Li XX, Zhao MW. Clinical characteristics of polypoidal choroidal vasculopathy in Chinese patients. Graefes Arch Clin Exp Ophthalmol. 2011;249:975–9.CrossRefPubMed Hou J, Tao Y, Li XX, Zhao MW. Clinical characteristics of polypoidal choroidal vasculopathy in Chinese patients. Graefes Arch Clin Exp Ophthalmol. 2011;249:975–9.CrossRefPubMed
7.
go back to reference Rouvas AA, Papakostas TD, Ntouraki A, Douvali M, Vergados I, Ladas ID. Photodynamic therapy, ranibizumab, and ranibizumab with photodynamic therapy for the treatment of polypoidal choroidal vasculopathy. Retina. 2011;31:464–74.CrossRefPubMed Rouvas AA, Papakostas TD, Ntouraki A, Douvali M, Vergados I, Ladas ID. Photodynamic therapy, ranibizumab, and ranibizumab with photodynamic therapy for the treatment of polypoidal choroidal vasculopathy. Retina. 2011;31:464–74.CrossRefPubMed
8.
go back to reference Sato T, Kishi S, Matsumoto H, Mukai R. Comparisons of outcomes with different intervals between adjunctive ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2013;156:95–105.CrossRefPubMed Sato T, Kishi S, Matsumoto H, Mukai R. Comparisons of outcomes with different intervals between adjunctive ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2013;156:95–105.CrossRefPubMed
9.
go back to reference Silva RM, Figueira J, Cachulo ML, Duarte L, Faria DAJ, Cunha-Vaz JG. Polypoidal choroidal vasculopathy and photodynamic therapy with verteporfin. Graefes Arch Clin Exp Ophthalmol. 2005;243:973–9.CrossRefPubMed Silva RM, Figueira J, Cachulo ML, Duarte L, Faria DAJ, Cunha-Vaz JG. Polypoidal choroidal vasculopathy and photodynamic therapy with verteporfin. Graefes Arch Clin Exp Ophthalmol. 2005;243:973–9.CrossRefPubMed
10.
go back to reference Sayanagi K, Gomi F, Sawa M, Ohji M, Tano Y. Long-term follow-up of polypoidal choroidal vasculopathy after photodynamic therapy with verteporfin. Graefes Arch Clin Exp Ophthalmol. 2007;245:1569–71.CrossRefPubMed Sayanagi K, Gomi F, Sawa M, Ohji M, Tano Y. Long-term follow-up of polypoidal choroidal vasculopathy after photodynamic therapy with verteporfin. Graefes Arch Clin Exp Ophthalmol. 2007;245:1569–71.CrossRefPubMed
11.
go back to reference Akaza E, Mori R, Yuzawa M. Long-term results of photodynamic therapy of polypoidal choroidal vasculopathy. Retina. 2008;28:717–22.CrossRefPubMed Akaza E, Mori R, Yuzawa M. Long-term results of photodynamic therapy of polypoidal choroidal vasculopathy. Retina. 2008;28:717–22.CrossRefPubMed
12.
go back to reference Cho HJ, Kim HS, Jang YS, Han JI, Lew YJ, Lee TG, et al. Effects of choroidal vascular hyperpermeability on anti-vascular endothelial growth factor treatment for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2013;156:1192–200.CrossRefPubMed Cho HJ, Kim HS, Jang YS, Han JI, Lew YJ, Lee TG, et al. Effects of choroidal vascular hyperpermeability on anti-vascular endothelial growth factor treatment for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2013;156:1192–200.CrossRefPubMed
13.
go back to reference Kang HM, Koh HJ. Long-term visual outcome and prognostic factors after intravitreal ranibizumab injections for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2013;156:652–60.CrossRefPubMed Kang HM, Koh HJ. Long-term visual outcome and prognostic factors after intravitreal ranibizumab injections for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2013;156:652–60.CrossRefPubMed
14.
go back to reference Sonoda S, Sakamoto T, Otsuka H, Yoshinaga N, Yamashita T, Ki-I Y, et al. Responsiveness of eyes with polypoidal choroidal vasculopathy with choroidal hyperpermeability to intravitreal ranibizumab. BMC Ophthalmol. 2013;13:43.CrossRefPubMedPubMedCentral Sonoda S, Sakamoto T, Otsuka H, Yoshinaga N, Yamashita T, Ki-I Y, et al. Responsiveness of eyes with polypoidal choroidal vasculopathy with choroidal hyperpermeability to intravitreal ranibizumab. BMC Ophthalmol. 2013;13:43.CrossRefPubMedPubMedCentral
15.
go back to reference Song JH, Byeon SH, Lee SC, Koh HJ, Kwon OW. Short-term safety and efficacy of a single intravitreal bevacizumab injection for the management of polypoidal choroidal vasculopathy. Ophthalmologica. 2009;223:85–92.CrossRefPubMed Song JH, Byeon SH, Lee SC, Koh HJ, Kwon OW. Short-term safety and efficacy of a single intravitreal bevacizumab injection for the management of polypoidal choroidal vasculopathy. Ophthalmologica. 2009;223:85–92.CrossRefPubMed
16.
go back to reference Mori R, Yuzawa M, Akaza E, Haruyama M. Treatment results at 1 year of ranibizumab therapy for polypoidal choroidal vasculopathy in eyes with good visual acuity. Jpn J Ophthalmol. 2013;57:365–71.CrossRefPubMed Mori R, Yuzawa M, Akaza E, Haruyama M. Treatment results at 1 year of ranibizumab therapy for polypoidal choroidal vasculopathy in eyes with good visual acuity. Jpn J Ophthalmol. 2013;57:365–71.CrossRefPubMed
17.
go back to reference Lai TY, Chan WM, Liu DT, Luk FO, Lam DS. Intravitreal bevacizumab (Avastin) with or without photodynamic therapy for the treatment of polypoidal choroidal vasculopathy. Br J Ophthalmol. 2008;92:661–6.CrossRefPubMed Lai TY, Chan WM, Liu DT, Luk FO, Lam DS. Intravitreal bevacizumab (Avastin) with or without photodynamic therapy for the treatment of polypoidal choroidal vasculopathy. Br J Ophthalmol. 2008;92:661–6.CrossRefPubMed
18.
go back to reference Kang HM, Koh HJ. Two-year outcome after combination therapy for polypoidal choroidal vasculopathy: comparison with photodynamic monotherapy and anti-vascular endothelial growth factor monotherapy. Ophthalmologica. 2014;231:86–93.CrossRefPubMed Kang HM, Koh HJ. Two-year outcome after combination therapy for polypoidal choroidal vasculopathy: comparison with photodynamic monotherapy and anti-vascular endothelial growth factor monotherapy. Ophthalmologica. 2014;231:86–93.CrossRefPubMed
19.
go back to reference Oishi A, Kojima H, Mandai M, Honda S, Matsuoka T, Oh H, et al. Comparison of the effect of ranibizumab and verteporfin for polypoidal choroidal vasculopathy: 12-month LAPTOP study results. Am J Ophthalmol. 2013;156:644–51.CrossRefPubMed Oishi A, Kojima H, Mandai M, Honda S, Matsuoka T, Oh H, et al. Comparison of the effect of ranibizumab and verteporfin for polypoidal choroidal vasculopathy: 12-month LAPTOP study results. Am J Ophthalmol. 2013;156:644–51.CrossRefPubMed
20.
go back to reference Inoue M, Arakawa A, Yamane S, Kadonosono K. Long-term outcome of intravitreal ranibizumab treatment, compared with photodynamic therapy, in patients with polypoidal choroidal vasculopathy. Eye (Lond). 2013;27:1013–20. 1021.CrossRef Inoue M, Arakawa A, Yamane S, Kadonosono K. Long-term outcome of intravitreal ranibizumab treatment, compared with photodynamic therapy, in patients with polypoidal choroidal vasculopathy. Eye (Lond). 2013;27:1013–20. 1021.CrossRef
21.
go back to reference Koh A, Lee WK, Chen LJ, Chen SJ, Hashad Y, Kim H, et al. EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina. 2012;32:1453–64.CrossRefPubMed Koh A, Lee WK, Chen LJ, Chen SJ, Hashad Y, Kim H, et al. EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina. 2012;32:1453–64.CrossRefPubMed
22.
go back to reference Mitamura Y, Kitahashi M, Kubota-Taniai M, Yamamoto S. Comparison of intravitreal bevacizumab to photodynamic therapy for polypoidal choroidal vasculopathy: short-term results. Indian J Ophthalmol. 2010;58:291–6.CrossRefPubMedPubMedCentral Mitamura Y, Kitahashi M, Kubota-Taniai M, Yamamoto S. Comparison of intravitreal bevacizumab to photodynamic therapy for polypoidal choroidal vasculopathy: short-term results. Indian J Ophthalmol. 2010;58:291–6.CrossRefPubMedPubMedCentral
23.
go back to reference Higgins JGS. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. 2011. Higgins JGS. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. 2011.
24.
go back to reference Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.CrossRefPubMedPubMedCentral Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.CrossRefPubMedPubMedCentral
25.
go back to reference Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62:1006–12.CrossRefPubMed Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62:1006–12.CrossRefPubMed
26.
28.
go back to reference Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.CrossRefPubMed Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.CrossRefPubMed
29.
go back to reference Wang W, He M, Zhang X. Combined intravitreal anti-VEGF and photodynamic therapy versus photodynamic monotherapy for polypoidal choroidal vasculopathy: a systematic review and meta-analysis of comparative studies. PLoS One. 2014;9:e110667.CrossRefPubMedPubMedCentral Wang W, He M, Zhang X. Combined intravitreal anti-VEGF and photodynamic therapy versus photodynamic monotherapy for polypoidal choroidal vasculopathy: a systematic review and meta-analysis of comparative studies. PLoS One. 2014;9:e110667.CrossRefPubMedPubMedCentral
30.
go back to reference Hirami Y, Tsujikawa A, Otani A, Yodoi Y, Aikawa H, Mandai M, et al. Hemorrhagic complications after photodynamic therapy for polypoidal choroidal vasculopathy. Retina. 2007;27:335–41.CrossRefPubMed Hirami Y, Tsujikawa A, Otani A, Yodoi Y, Aikawa H, Mandai M, et al. Hemorrhagic complications after photodynamic therapy for polypoidal choroidal vasculopathy. Retina. 2007;27:335–41.CrossRefPubMed
31.
go back to reference Lee YA, Yang CH, Yang CM, Ho TC, Lin CP, Huang JS, et al. Photodynamic therapy with or without intravitreal bevacizumab for polypoidal choroidal vasculopathy: two years of follow-up. Am J Ophthalmol. 2012;154:872–80.CrossRefPubMed Lee YA, Yang CH, Yang CM, Ho TC, Lin CP, Huang JS, et al. Photodynamic therapy with or without intravitreal bevacizumab for polypoidal choroidal vasculopathy: two years of follow-up. Am J Ophthalmol. 2012;154:872–80.CrossRefPubMed
32.
go back to reference Lai TY, Lee GK, Luk FO, Lam DS. Intravitreal ranibizumab with or without photodynamic therapy for the treatment of symptomatic polypoidal choroidal vasculopathy. Retina. 2011;31:1581–8.CrossRefPubMed Lai TY, Lee GK, Luk FO, Lam DS. Intravitreal ranibizumab with or without photodynamic therapy for the treatment of symptomatic polypoidal choroidal vasculopathy. Retina. 2011;31:1581–8.CrossRefPubMed
33.
go back to reference Saito M, Iida T, Kano M. Intravitreal ranibizumab for polypoidal choroidal vasculopathy with recurrent or residual exudation. Retina. 2011;31:1589–97.CrossRefPubMed Saito M, Iida T, Kano M. Intravitreal ranibizumab for polypoidal choroidal vasculopathy with recurrent or residual exudation. Retina. 2011;31:1589–97.CrossRefPubMed
Metadata
Title
Photodynamic therapy versus anti-vascular endothelial growth factor agents for polypoidal choroidal vasculopathy: A meta-analysis
Authors
Meng Yong
Minwen Zhou
Guohua Deng
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Ophthalmology / Issue 1/2015
Electronic ISSN: 1471-2415
DOI
https://doi.org/10.1186/s12886-015-0064-5

Other articles of this Issue 1/2015

BMC Ophthalmology 1/2015 Go to the issue