Table 4.
Summary of comparison of monotherapies and combination treatment
| Groups | Mean change in BCVA from baseline | Mean change in CRT from baseline | Polypoidal regression rate | Adverse effect |
|---|---|---|---|---|
| PDT monotherapy versus anti-VEGF mono | ||||
| Yong et al., 2015[213] | PDT is comparable to anti-VEGF therapy at all follow-up time points111 | PDT was more effective in CRT reduction than anti-VEGF at 6 months posttreatment (P=0.002) (WMD, 44.94; 95% CI, 16.44-73.44) with heterogeneity (I2=30.3%) | PDT was more effective than anti-VEGF in achieving regression of polyps. (OR: 6.85; 95% CI: 2.15-21.79; P=0.001) with heterogeneity (I2=64.4%) | |
| Qian et al., 2018[214] | Anti-VEGF therapy significantly reduced CRT compared with PDT at 3 months (P=0.04) with no heterogeneity (I2=0%) | PDT was more effective than anti-VEGF in achieving regression of polyps at 3 months and 6 or more months (P<0.00001, I2=36%; and P=0.0001, I2=0% respectively) | ||
| Combination treatment versus PDT monotherapy | ||||
| Wang et al., 2014[215] | Combination therapy was significantly better at 12 months (WMD: 0.11, 95% CI: 0.012-0.21; P=0.028) with I2=0% and 24 months (WMD: 0.21; 95% CI: 0.054-0.36; P=0.008) with I2=0% Improvement in mean VA seemed to decrease with time in the PDT monotherapy group | No statistically significance in the change in CRT though was greater in the combination group than the PDT monotherapy group | No statistically significant difference between groups | Significantly lower rate of retinal hemorrhage in the combination treatment group. (OR: 0.32; 95% CI: 0.14-0.74; P=0.008) with I2=5.10% |
| Qian et al., 2018[214] | Combination treatment resulted in significantly greater improvements in BCVA than PDT monotherapy at 3, 6, 12, and 24 months after treatment in patients with PCV (P=0.03 with I2=0%; P=0.005 with I2=0%; P=0.02 with I2=21%; and P<0.0001 with I2=50%, respectively) | Combination treatment resulted in significantly greater reductions in CRT at 3 months than PDT alone (P=0.02) | No significant differences in polyp regression were observed between the two groups | Combination therapy had significantly lower incidence of subretinal hemorrhage during the follow-up period, (P=0.02) with no heterogeneity (I2=38%) |
| Combination treatment versus anti-VEGF monotherapy | ||||
| Liu et al., 2017[216] | Combination treatment was significantly better than IVR monotherapy group at 12 (WMD: 0.132; 95% CI, 0.029-0.234, P=0.012) with heterogeneity I2=0% and 24 months (WMD: 0.234; 95% CI, 0.071-0.398, P=0.005) with heterogeneity I2=6.3% | N/A | N/A | N/A |
| Qian et al., 2018[214] | Combination treatment resulted in significantly greater improvements compared with anti-VEGF treatment at 6 and 24 months (P=0.001; P<0.00001, respectively), with no heterogeneity (I2=0%; I2=0%, respectively) | No significant differences in CRT reduction at follow-up point of 6 and 12 months | Significant proportion of polyp regression at 3 and ≥6 months in the combination therapy (P<0.00001; P<0.0001, respectively) with no heterogeneity I2=35% | No significant difference in the incidence of subretinal haemorrhage (P=085) (I2=0%) |
WMD = Weighted mean differences, CI = Confidence interval, OR = Odds ratio, CRT=Central retinal thickness, BCVA = Best-corrected visual acuity, PDT = Photodynamic therapy, VEGF = Vascular endothelial growth factor