Summary of findings for the main comparison. Anti‐VEGF compared with control for choroidal neovascularisation in people with pathological myopia.
| Anti‐VEGF compared with control for choroidal neovascularisation in people with pathological myopia | ||||||
| Patient or population: CNV in people with pathologic myopia Setting: clinical centres Intervention: intravitreal injections of anti‐VEGF Comparison: PDT | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with PDT | Risk with anti‐VEGF | |||||
| Change in visual acuity at 1 year assessed with: logMAR | The mean change in visual acuity at 1 year ranged from ‐0.186 to 0.15 logMAR | The mean change in visual acuity at 1 year in the intervention group was 0.14 logMAR lower (better) (0.2 lower to 0.08 lower) | ‐ | 263 (3 RCTs) | ⊕⊕⊕⊝ Low1 2 | Overall heterogeneity: I2 = 68% |
| Gain 3+ lines of visual acuity at 1 year | 265 per 1000 | 493 per 1000 (337 to 724) | RR 1.86 (1.27 to 2.73) | 226 (2 RCTs) | ⊕⊕⊕⊝ Moderate 1 | Overall heterogeneity: I2 = 58% |
| Change in central macular thickness at 1 year | The mean change in central macular thickness at 1 year ranged from ‐14 μm to ‐60.8 μm | The mean change in central macular thickness at 1 year in the intervention group was 17.84 μm greater reduction (6.3 lower reduction to 41.98 greater reduction) | ‐ | 226 (2 RCTs) | ⊕⊕⊕⊝ Moderate 2 | Overall heterogeneity: I2 = 2% |
| CNV angiographic closure at 1 year | 562 per 1000 | 697 per 1000 (556 to 865) | RR 1.24 (0.99 to 1.54) | 208 (2 RCTs) | ⊕⊕⊝⊝ Low 1 2 | Overall heterogeneity: I2 = 83% |
| Systemic serious adverse events | 1 per 1000 | 5 per 1000 (1 to 34) | RR 4.50 (0.60 to 33.99) |
508 (4 RCTs) | ⊕⊝⊝⊝ Very low 3 | Estimate of effect taken from trials comparing anti‐VEGF to other, sham or no treatment. As no events reported in the control groups of these studies, we assumed a low absolute risk of 1 per 1000 in the comparator group for illustrative purposes only. |
| Ocular adverse events | 1 per 1000 | 2 per 1000 (0 to 15) | RR 1.82 (0.23 to 14.71) |
508 (4 RCTs) | ⊕⊝⊝⊝ Very low 4 | |
| Quality of life | Mean change in NEI‐VFQ (with sham) ‐2.58 | The mean change in score was 5.72 better (1.60 better to 9.84 better) | 121 (1 RCT) |
⊕⊕⊕⊝ Moderate 2 | ‐ | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). One study allowed anti‐VEGF treatment (ranibizumab) as of month 3 in participants randomised to PDT. Anti‐VEGF: anti‐vascular endothelial growth factor; CI: confidence interval; CNV: choroidal neovascularisation; NEI‐VFQ: National Eye Institute Visual Function Questionnaire; PDT: photodynamic therapy; RCT: randomised controlled trial; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High‐certainty: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate‐certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low‐certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low‐certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | ||||||
1 Downgraded 1 level for inconsistency as I2 greater than 50%. Note: one study allowed anti‐VEGF (ranibizumab) treatment as of month 3 in participants randomised to PDT.
2 Downgraded 1 level for imprecision as confidence intervals include null value or clinically insignificant effect.
3 Downgraded 2 levels for imprecision as only 15 events, and downgraded 1 level for indirectness as people with previous cardiovascular events were excluded in these studies.
4 Downgraded 2 levels for imprecision as only 5 events, downgraded 1 level for indirectness as people with concomitant ocular disease such as glaucoma were excluded in these studies.