Table 2.
Studies on treatments other than anti-vascular endothelial growth factor drugs in the treatment of the non-proliferative phase of MacTel
| Treatment | Author, year | Study design, evidence level | Eyes (patients) | F/U (m) | Regimen; protocol | Functional outcomes | Structural outcomes | Support for intervention |
|---|---|---|---|---|---|---|---|---|
| IVT | Toklu, 2011 [40] | Case report, – | 2 (1) | 3 | 4 mg triamcinolone acetonide (OD) and 1.25 mg IVB (OS); a single dose injection |
BCVA at 1st week post treatment: 5/100 (OD) and 5/10 (OS) improved to 5/10 and 10/10, respectively BCVA at 1 month and 3 months: similar to the 1st week |
FA hyperfluorescence: began to decrease at the 1st week post treatment, which remained the same during 3 months (OU) | + |
| PPV | Sigler, 2013 [42] | Case series, IV | 5 (3) | 24 | PPV ± ILM peeling | BCVA improved significantly in 2 eyes, stabilized in 2 eyes, and reduced in 1 eye | * No improvement in structural changes in OCT | + |
| Laser | Steigerwalt, 2012 [38] | Case report, – | 1 (1) | 4 | ICG-DEP; 4 focal argon laser treatments at 2-3 weeks intervals |
No change in BCVA No change in central scotoma |
* Decrease in CMT from 487 µm to 239 µm | + |
| Meyer, 2013 [24] | Retrospective cohort, IV | 33 (19) | 81 (40–160) | 4 eyes received frequency doubled YAG-laser (532 nm) vs. 29 untreated eyes |
BCVA change at 3 years: – 1.2 ± 1.5 lines in untreated eyes – 1.9 ± 1.9 lines in photocoagulation group (not significant) BCVA change at 5 years: – 2.0 ± 2.4 lines in untreated eyes – 2.8 ± 2.2 lines in photocoagulation group (not significant) |
No significant difference in structural changes in OCT compared with the CG | ||
| Zehetner, 2013 [41] | Case series, IV | 5 (4) | 12 | Treating with reduced-fluence PDT and then intravitreal ranibizumab within 24 h (2 eyes received re-treatment with the same regimen after 6 months) | 2 eyes with improved BCVA, 2 eyes with worsened BCVA, and 1 eye with no change in BCVA | No report of structural outcome | ||
| CAI | Chen, 2014 [33] | Retrospective cohort, IV | 26 (13) |
5.8 (1–9) |
Methazolamide 50 mg BD (4 patients) or acetazolamide (4 patients) 500 mg BD or observation (5 patients) | 1–2 letter improvement in BCVA, but not significant |
Reduced cystic changes and CMT in acetazolamide group but not methazolamide compared with the control group; CMT change in cetazolamide group: – 20.1 ± 10.0 µm, p = 0.007 CMT change in methazolamide group: – 6.25 ± 8.73 µm, p = 0.177 |
+ |
| Carotenoid | Tan, 2016 [39] | Retrospective cohort IV | 26 (13) | 15 ± 5 | Treating all patients with lutein 10 mg, meso-zeaxanthin 10 mg, and zeaxanthin 2 mg daily | Improved BCVA in 13% of patients and a reduction in the percentage of patients who had a worsening vision (25–4%; p < 0.05) | Mild improvement in OCT structures in the first 6 months after starting LMZ3 supplements | ++ |
| Choi, 2017 [36] | RCT, I b | 16 (8) | 24 | Randomized to 10 or 20 milligrams/day of zeaxanthin | Subjective BCVA improvement but no improvement in objective BCVA |
Enhanced ring-shaped pattern of macular pigment without increase in pigment concentration at the central fovea No improvement in foveal OCT structures |
||
| CNTF | Chew, 2015 [35] |
Clinical trial (evaluation of safety), II b |
14 (7) | 36 | Unilateral implantation of the CNTF-secreting capsule (eye with worse VA) vs. untreated fellow eyes | BCVA and microperimetry scotoma remained unchanged from the baseline |
OCT structures and ERG dark adaptation remained unchanged from the baseline Safe and well tolerated |
|
| Clemons, 2016 [37] | Clinical trial, II b | 14 (7) | 48 | Unilateral implantation of the CNTF-secreting capsule (eye with worth VA) vs. untreated fellow eyes |
BCVA improvement in treated eyes (compared with the control eyes: +6.67 ± 1.52 letter, p = 0.007) Improved microperimetry in treated eyes (p = 0.05) |
No significant difference in OCT structures | + | |
| Chew, 2018 [34] | Clinical trial, II b | 99 (67) | 24 | Patients were randomized 1:1 to implantation of the CNTF-secreting capsule and sham |
At 24 months: The difference in mean retinal sensitivity in microperimetry was 15.81 ± 8.93 dB (p = 0.07) which means 45% greater loss in sham group Reading speed did not reduce in treatment group, while reduced -13.9 words per minute in sham (p = 0.02) |
At 24 months: The difference in mean area of photoreceptor disruption (photoreceptor loss) was 0.05 ± 0.03 mm2 (p = 0.04), which means 31% greater progression of neurodegeneration in sham group |
++ |
CAI carbonic anhydrase inhibitor, CG control group, CMT central macular thickness, CNTF ciliary neurotrophic factor, ERG electroretinogram, FA fluorescein angiography, F/U follow-up, ICG-DEP indocyanine green dye-enhanced photocoagulation, IVB intravitreal bevacizumab, IVT intravitreal triamcinolone, OCT optical coherent tomography, PDT photodynamic therapy, PPV pars plana vitrectomy, RCT randomized clinical trial, TG trial group, TPT temporal parafoveal thickness, BCVA best corrected visual acuity