Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Glachs, L.
Treatment of myopic choroidal neovascularization: a network meta-analysis and review
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2023. pp. 64
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Posch-Pertl Laura
- Wedrich Andreas
- Altmetrics:
- Abstract:
- Purpose Treatment options of myopic choroidal neovascularization (CNV) include verteporfin-photodynamic therapy (PDT), surgical treatment, intravitreal triamcinolone (TCA) and anti-vascular endothelial growth factor (anti-VEGF). A network meta-analysis, comparing different treatments has not been carried out yet. Methods Electronic databases and the Web of Science were searched for different therapies and myopic CNV from database inception to 7/2020. Retrieved titles, abstracts, full-texts and their results were summarized by two independent reviewers. Treatment’s efficacy was determined by two primary endpoints: improvement in best-corrected visual acuity (BCVA) in letters and anatomical changes in central retinal thickness (CRT) in micrometers. Results were divided into early (≤6 months) and late phase (>6 months). Subgroup analyses of different anti-VEGF agents, their treatment regimen and injection number were performed. Results Thirty-four studies (2.016 eyes) were included in the quantitative network meta-analysis. In the early phase, the use of anti-VEGF resulted in an increase of 14.1 letters (95 % CI, 10.8-17.4; p<0.0001) compared to untreated, of 12.1 (95 % CI, 8.3-15.9; p<0.0001) to PDT and of 7.5 (95 % CI, 1.2-13.8; p=0.019) to TCA. In the later phase, these results were largely maintained. In the early phase, anti-VEGF led to a decrease in CRT in comparison to untreated (66.8 μm; 95 % CI, 40.2-93.4; p<0.0001) and to PDT (27.7 μm; 95 % CI, 16.1–39.3; p<0.0001). Combination of PDT and anti-VEGF resulted in a greater decrease in CRT compared to anti-VEGF alone (12.0 μm; 95 % CI, 21.4-2.6; p=0.013). The different VEGF inhibitors showed similar results, except that aflibercept showed a greater decrease in CRT compared to bevacizumab (12.1 μm; 95 % CI, 3.0-21.2; p=0.009; ≤6 months). There were no significant differences whether anti-VEGF was applicated as one initial (1+pro re nata (PRN)) or three initial doses (3+PRN). However, the 1+PRN group received 1.8 (SD 1.3) injections, while the 3+PRN received 3.2 (SD 0.9) within twelve months (p<0.0001). Conclusion This network meta-analysis confirms that the first-line therapy for myopic CNV are VEGF inhibitors. Different anti-VEGF drugs appear equally effective. 1+PRN regimen seems reasonable to keep the injection number low.