Treatment of myopic choroidal neovascularization: a network meta-analysis and review

Abstract

Purpose: This is, to our knowledge, the first network meta-analysis aiming to compare all treatment modalities for myopic choroidal neovascularization (CNV).

Methods: After the electronic databases were searched, two independent reviewers screened titles, abstracts, full-texts, and extracted information. Primary endpoints were change in visual outcome and central retinal thickness. We used a network meta-analysis to compare treatment outcomes in the early (≤ 6 months) and late (> 6 months) phase.

Results: We included 34 studies (2,098 eyes) in our network meta-analysis. In the early phase, the use of anti-VEGF led to a gain of 14.1 letters (95% CI, 10.8-17.4) compared to untreated patients (p < 0.0001), 12.1 letters (95% CI, 8.3-15.8) to photodynamic therapy (PDT) (p < 0.0001), 7.5 (95% CI, 1.2-13.8) letters to intravitreal triamcinolone acetonide (TCA) (p = 0.019), and - 2.9 letters (95% CI, - 6.0-0.2) to the combination of anti-VEGF and PDT (p = 0.065). In the later phase, these results were largely maintained. There were no significant differences in visual outcomes between patients treated with 1 + PRN and 3 + PRN. However, the 1 + PRN group received 1.8 (SD 1.3), while the 3 + PRN group received 3.2 (SD 0.9) injections within 12 months (p < 0.0001).

Conclusion: This network meta-analysis confirms that anti-VEGF is the most effective treatment for myopic CNV using the 1 + PRN treatment strategy.

Keywords: Aflibercept; Anti-VEGF; Bevacizumab; Choroidal neovascularization; Conbercept; Myopia; Myopic CNV; Photodynamic therapy; Ranibizumab.

Fig. 1

PRISMA flow diagram adapted by Page et al. [9]

Fig. 2

The structure of the network comparing different treatments regarding BCVA in the early phase (< 6 month). The numbers represent the numbers of direct comparisons, while the thickness of the lines is proportional to the inverse standard error of the estimates. BCVA, best-corrected visual acuity; PDT, photodynamic treatment; TCA, intravitreal triamcinolone acetonide; VEGF, vascular endothelial growth factors

Fig. 3

Forrest plot comparing change in BCVA (letters) before six months in the anti-VEGF treatment group compared to the other treatment groups. CI, confidence interval; MD, mean difference; PDT, photodynamic treatment; TCA, intravitreal triamcinolone acetonide; VEGF, vascular endothelial growth factors

Fig. 4

The structure of the network comparing different treatments regarding BCVA in the early phase (< 6 month). The numbers represent the numbers of direct comparisons, while the thickness of the lines is proportional to the inverse standard error of the estimates. PDT, photodynamic treatment; TCA, intravitreal triamcinolone acetonide; VEGF, vascular endothelial growth factors

Fig. 5

Forrest plot comparing change in central retinal thickness before six months in the anti-VEGF treatment group compared to the other treatment groups. CI, confidence interval; MD, mean difference; PDT, photodynamic treatment; VEGF, vascular endothelial growth factors

Fig. 6

The structure of the network comparing different treatments regarding BCVA in the early phase (< 6 month). The numbers represent the numbers of direct comparisons, while the thickness of the lines is proportional to the inverse standard error of the estimates. BCVA, best-corrected visual acuity; PDT, photodynamic treatment; TCA, intravitreal triamcinolone acetonide; VEGF, vascular endothelial growth factors

Fig. 7

Forrest plot comparing change in BCVA after six months in the anti-VEGF treatment group compared to the other treatment groups. CI, confidence interval; MD, mean difference; PDT, photodynamic treatment; TCA, intravitreal triamcinolone acetonide; VEGF, vascular endothelial growth factors

Fig. 8

The structure of the network comparing different treatments regarding BCVA in the early phase (< 6 month). The numbers represent the numbers of direct comparisons, while the thickness of the lines is proportional to the inverse standard error of the estimates. PDT, photodynamic treatment; VEGF, vascular endothelial growth factors

Fig. 9

Forrest plot comparing change in central retinal thickness after six months in the anti-VEGF treatment group compared to the other treatment groups. CI, confidence interval; MD, mean difference; PDT, photodynamic treatment; TCA, intravitreal triamcinolone acetonide; VEGF, vascular endothelial growth factors