Comparative efficacy of photodynamic therapy (PDT), ranibizumab, aflibercept monotherapy, and combination therapies for polypoidal choroidal vasculopathy: a network meta-analysis of randomized controlled trials
Abstract Purpose Polypoidal choroidal vasculopathy (PCV) is recognized as a distinct clinical condition characterized by persistent serous leakage, bleeding, and the presence of polypoidal lesions beneath the retinal pigment epithelium (RPE). This systematic review and meta-analysis aimed to evaluat...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-07-01
|
| Series: | BMC Ophthalmology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12886-025-04249-8 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849345328835198976 |
|---|---|
| author | Miguel A. Quiroz-Reyes Erick A. Quiroz-Gonzalez Miguel A. Quiroz-Gonzalez Virgilio Lima-Gomez |
| author_facet | Miguel A. Quiroz-Reyes Erick A. Quiroz-Gonzalez Miguel A. Quiroz-Gonzalez Virgilio Lima-Gomez |
| author_sort | Miguel A. Quiroz-Reyes |
| collection | DOAJ |
| description | Abstract Purpose Polypoidal choroidal vasculopathy (PCV) is recognized as a distinct clinical condition characterized by persistent serous leakage, bleeding, and the presence of polypoidal lesions beneath the retinal pigment epithelium (RPE). This systematic review and meta-analysis aimed to evaluate the effectiveness of combination treatments that include antivascular endothelial growth factor (anti-VEGF) agents, such as ranibizumab and aflibercept, along with photodynamic therapy (PDT), in comparison to monotherapy options for managing PCV. Methods A comprehensive literature search was performed in PubMed, Web of Science, and the Cochrane Library, following the PRISMA guidelines. Eligible studies consisted of treatment-naïve patients with PCV receiving anti-VEGF monotherapy, PDT monotherapy, or combination therapies. The key outcomes analyzed included changes in best-corrected visual acuity (BCVA), reduction in central subfield thickness (CSFT), rate of polyp regression, incidence of adverse events, and treatment burden. Statistical analyses were conducted via a random-effects model, and heterogeneity was assessed via the I² statistic. Results Fourteen randomized controlled trials (RCTs) involving 1,426 eyes were included. Compared with monotherapies, combination therapies, especially anti-VEGF in conjunction with PDT, showed superior efficacy in improving the BCVA (mean difference [MD] = 0.07, 95% CI: 0.06–0.08) and reducing the CSFT (MD = -42.09 μm, 95% CI: -59.93 -24.24). The regression rates of polyps were highest in the combination groups, with up to 77.8% achieving complete regression, and fewer anti-VEGF injections were required than monotherapies. Adverse event rates, such as subretinal hemorrhage, remained low across all treatment groups. Conclusion Compared with monotherapy, combination therapies using anti-VEGF agents and PDT provide significant visual and anatomical advantages in managing PCV. These treatments are associated with improved efficacy and a reduced treatment burden while maintaining favorable safety profiles. However, further standardization of protocols and evaluation of long-term cost-effectiveness are crucial for improving clinical practice applications. Trial registration Retrospectively registered. |
| format | Article |
| id | doaj-art-835a81645b33485ea3a13ca4b59bce36 |
| institution | Kabale University |
| issn | 1471-2415 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Ophthalmology |
| spelling | doaj-art-835a81645b33485ea3a13ca4b59bce362025-08-20T03:42:30ZengBMCBMC Ophthalmology1471-24152025-07-0125111710.1186/s12886-025-04249-8Comparative efficacy of photodynamic therapy (PDT), ranibizumab, aflibercept monotherapy, and combination therapies for polypoidal choroidal vasculopathy: a network meta-analysis of randomized controlled trialsMiguel A. Quiroz-Reyes0Erick A. Quiroz-Gonzalez1Miguel A. Quiroz-Gonzalez2Virgilio Lima-Gomez3The Retina Department. Oftalmología Integral ABC (Medical and Surgical Nonprofit Organization), National Autonomous University of Mexico, Lomas de ChapultepecThe Retina Department. Oftalmología Integral ABC (Medical and Surgical Nonprofit Organization), National Autonomous University of Mexico, Lomas de ChapultepecThe Retina Department. Oftalmología Integral ABC (Medical and Surgical Nonprofit Organization), National Autonomous University of Mexico, Lomas de ChapultepecHospital Juárez, Institución de Asistencia Pública (Organización Sin Fines de Lucro), Colonia Magdalena de las SalinasAbstract Purpose Polypoidal choroidal vasculopathy (PCV) is recognized as a distinct clinical condition characterized by persistent serous leakage, bleeding, and the presence of polypoidal lesions beneath the retinal pigment epithelium (RPE). This systematic review and meta-analysis aimed to evaluate the effectiveness of combination treatments that include antivascular endothelial growth factor (anti-VEGF) agents, such as ranibizumab and aflibercept, along with photodynamic therapy (PDT), in comparison to monotherapy options for managing PCV. Methods A comprehensive literature search was performed in PubMed, Web of Science, and the Cochrane Library, following the PRISMA guidelines. Eligible studies consisted of treatment-naïve patients with PCV receiving anti-VEGF monotherapy, PDT monotherapy, or combination therapies. The key outcomes analyzed included changes in best-corrected visual acuity (BCVA), reduction in central subfield thickness (CSFT), rate of polyp regression, incidence of adverse events, and treatment burden. Statistical analyses were conducted via a random-effects model, and heterogeneity was assessed via the I² statistic. Results Fourteen randomized controlled trials (RCTs) involving 1,426 eyes were included. Compared with monotherapies, combination therapies, especially anti-VEGF in conjunction with PDT, showed superior efficacy in improving the BCVA (mean difference [MD] = 0.07, 95% CI: 0.06–0.08) and reducing the CSFT (MD = -42.09 μm, 95% CI: -59.93 -24.24). The regression rates of polyps were highest in the combination groups, with up to 77.8% achieving complete regression, and fewer anti-VEGF injections were required than monotherapies. Adverse event rates, such as subretinal hemorrhage, remained low across all treatment groups. Conclusion Compared with monotherapy, combination therapies using anti-VEGF agents and PDT provide significant visual and anatomical advantages in managing PCV. These treatments are associated with improved efficacy and a reduced treatment burden while maintaining favorable safety profiles. However, further standardization of protocols and evaluation of long-term cost-effectiveness are crucial for improving clinical practice applications. Trial registration Retrospectively registered.https://doi.org/10.1186/s12886-025-04249-8AfliberceptBrolucizumabCentral subfield thicknessFaricimabPhotodynamic therapyNeovascular age-related macular degeneration |
| spellingShingle | Miguel A. Quiroz-Reyes Erick A. Quiroz-Gonzalez Miguel A. Quiroz-Gonzalez Virgilio Lima-Gomez Comparative efficacy of photodynamic therapy (PDT), ranibizumab, aflibercept monotherapy, and combination therapies for polypoidal choroidal vasculopathy: a network meta-analysis of randomized controlled trials BMC Ophthalmology Aflibercept Brolucizumab Central subfield thickness Faricimab Photodynamic therapy Neovascular age-related macular degeneration |
| title | Comparative efficacy of photodynamic therapy (PDT), ranibizumab, aflibercept monotherapy, and combination therapies for polypoidal choroidal vasculopathy: a network meta-analysis of randomized controlled trials |
| title_full | Comparative efficacy of photodynamic therapy (PDT), ranibizumab, aflibercept monotherapy, and combination therapies for polypoidal choroidal vasculopathy: a network meta-analysis of randomized controlled trials |
| title_fullStr | Comparative efficacy of photodynamic therapy (PDT), ranibizumab, aflibercept monotherapy, and combination therapies for polypoidal choroidal vasculopathy: a network meta-analysis of randomized controlled trials |
| title_full_unstemmed | Comparative efficacy of photodynamic therapy (PDT), ranibizumab, aflibercept monotherapy, and combination therapies for polypoidal choroidal vasculopathy: a network meta-analysis of randomized controlled trials |
| title_short | Comparative efficacy of photodynamic therapy (PDT), ranibizumab, aflibercept monotherapy, and combination therapies for polypoidal choroidal vasculopathy: a network meta-analysis of randomized controlled trials |
| title_sort | comparative efficacy of photodynamic therapy pdt ranibizumab aflibercept monotherapy and combination therapies for polypoidal choroidal vasculopathy a network meta analysis of randomized controlled trials |
| topic | Aflibercept Brolucizumab Central subfield thickness Faricimab Photodynamic therapy Neovascular age-related macular degeneration |
| url | https://doi.org/10.1186/s12886-025-04249-8 |
| work_keys_str_mv | AT miguelaquirozreyes comparativeefficacyofphotodynamictherapypdtranibizumabafliberceptmonotherapyandcombinationtherapiesforpolypoidalchoroidalvasculopathyanetworkmetaanalysisofrandomizedcontrolledtrials AT erickaquirozgonzalez comparativeefficacyofphotodynamictherapypdtranibizumabafliberceptmonotherapyandcombinationtherapiesforpolypoidalchoroidalvasculopathyanetworkmetaanalysisofrandomizedcontrolledtrials AT miguelaquirozgonzalez comparativeefficacyofphotodynamictherapypdtranibizumabafliberceptmonotherapyandcombinationtherapiesforpolypoidalchoroidalvasculopathyanetworkmetaanalysisofrandomizedcontrolledtrials AT virgiliolimagomez comparativeefficacyofphotodynamictherapypdtranibizumabafliberceptmonotherapyandcombinationtherapiesforpolypoidalchoroidalvasculopathyanetworkmetaanalysisofrandomizedcontrolledtrials |