scholarly journals Systematic review with network meta-analysis of antivascular endothelial growth factor use in managing polypoidal choroidal vasculopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sheng-Chu Chi ◽  
Yi-No Kang ◽  
Yi-Ming Huang
Keyword(s):  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Evaluation Methodology ◽  
Combination Group ◽  
Anti Vegf ◽  
Searching Strategy ◽  
Early Combination Therapy ◽  
Choroidal Vasculopathy

AbstractPolypoidal choroidal vasculopathy (PCV) is a vision-threatening disease common in Asian populations. However, the optimal treatment for PCV remains under debate. We searched the databases with optimal searching strategy. The study included randomized clinical trials and prospective studies that recruited patients with active PCV who had received interventions, including PDT, anti-VEGF, or a combination of PDT and anti-VEGF. The Grading of Recommendations Assessment, Development, and Evaluation methodology was used for rating the quality of evidence. Our study included 11 studies involving 1277 patients. The network meta-analysis of RCTs revealed the anti-VEGF group, early combination group, and late combination group had significant BCVA changes compared with the PDT group. Early combination therapy led to a significant decrease in CRT compared with PDT, anti-VEGF, and late combination therapy. Additionally, the early combination group had a significantly higher complete polyp regression rate than the anti-VEGF group. No significant differences were detected in the analysis of the number of anti-VEGF injections and safety profile. This network meta-analysis revealed that early combination therapy exhibited better efficacy related to anatomical outcomes than other therapies. Nonetheless, no significant differences related to BCVA change could be detected between anti-VEGF and late combination therapy.

scholarly journals Five-year visual outcomes after anti-VEGF therapy with or without photodynamic therapy for polypoidal choroidal vasculopathy

2018 ◽  
Vol 103 (5) ◽  
pp. 617-622 ◽  
Author(s):  
Manabu Miyata ◽  
Sotaro Ooto ◽  
Kenji Yamashiro ◽  
Hiroshi Tamura ◽  
Masayuki Hata ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Fundus Photography ◽  
Combination Group ◽  
Macular Atrophy ◽  
Anti Vegf ◽  
Significant Difference ◽  
Treatment Naïve ◽  
Choroidal Vasculopathy

Background/aimsTo evaluate the 5-year visual and anatomical outcomes after anti-vascular endothelial growth factor (VEGF) therapy alone or in combination with photodynamic therapy (PDT), followed by pro re nata (PRN) anti-VEGF therapy with or without PDT, for polypoidal choroidal vasculopathy (PCV).MethodsThis retrospective, observational study included 61 consecutive patients with treatment-naïve symptomatic PCV who were followed for 5 years. Twenty eyes (20 patients) initially received PDT and intravitreal injection of ranibizumab (IVR), followed by a PRN regimen of anti-VEGF therapy with or without PDT (combination group), while 41 eyes (41 patients) initially received only IVR every 3 months, followed by a PRN regimen of anti-VEGF monotherapy (IVR group). Macular atrophy including the fovea was confirmed using colour fundus photography and spectral-domain optical coherence tomography.ResultsIn both groups, the visual acuity (VA) at 1 year was better than the baseline VA, whereas the 3-year, 4-year and 5-year VA values were similar to the baseline VA. There was no significant difference in the 5-year VA, 5-year central retinal thickness and incidence of macular atrophy between the two groups (p=0.63, 0.72 and 0.06, respectively). In the combination group, the 5-year VA was correlated with the 5-year incidence of macular atrophy (p=0.02, r=0.51).ConclusionsA PRN regimen for PCV may have a limited effect for the long-term maintenance of improved VA. Macular atrophy may occur more frequently with combination therapy and is possibly associated with the 5-year VA. Thus, combination therapy should be carefully selected for patients susceptible to macular atrophy.

scholarly journals CHOROIDAL VASCULARITY INDICES AND COEXISTING MORPHOLOGICAL CHANGES IN POLYPOIDAL CHOROIDAL VASCULOPATHY. A COMPARATIVE ANALYSIS BETWEEN TWO TREATMENT STRATEGIES

2021 ◽  
pp. 128-131
Author(s):  
Divya Alex
Keyword(s):  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Choroidal Thickness ◽  
Morphological Changes ◽  
Treatment Strategies ◽  
Enhanced Depth Imaging ◽  
Anti Vegf ◽  
Luminal Area ◽  
Imagej Software ◽  
Choroidal Vasculopathy

Purpose: Compare the effect of Combination therapy (PDT+Anti-VEGF) and Anti-VEGF monotherapy on choroidal vascularity indices and morphological parameters in Polypoidal Choroidal Vasculopathy (PCV). Methods: Retrospective, cohort study involving 33eyes with a diagnosis of PCV and had visible sclerochoroidal boundary on enhanced depth imaging. Cases were treated either with combination (n=17) or Anti-VEGF monotherapy (n=16). Demographic details, visual acuity assessment, OCT analysis was considered from baseline to the 3rd and 6th month follow-up visits. Choroidal vascularity analysis including choroidal thickness, Total Choroidal Surface Area (TCSA), Total Stromal area (TSA), Total Luminal Area (TLA) and Choroidal Vascularity Index (CVI) assessment were done with ImageJ software using the technique of image binarization. Results: Disease activity was significantly higher in the Anti-VEGF monotherapy arm compared to the combination therapy arm both at 3 and 6 months. When compared to baseline values, there was statistically significant decrease in choroidal thickness, Double layer sign (DLS) width, TCSA, TSA and TLA (P<0.05) in the combination therapy arm. Whereas, Anti-VEGF monotherapy arm showed an increase in the mean sub foveal choroidal thickness and DLS width at both visits. Complete collapse of PED, reduction in DLS width which was achieved only in combination therapy arm showed significant positive correlation with the resolution of the disease. CVI did not show a statistically significant reduction in both the arms. Conclusion: In view of better outer retinal and choroidal morphological changes and vascular remodelling, our study strongly supports the superiority of combination therapy over Anti-VEGF monotherapy in PCV

scholarly journals Genetic Variants Affecting Anti-VEGF Drug Response in Polypoidal Choroidal Vasculopathy Patients: A Systematic Review and Meta-Analysis

Genes ◽  
2020 ◽  
Vol 11 (11) ◽  
pp. 1335
Author(s):  
Xando Díaz-Villamarín ◽  
David Blánquez-Martínez ◽  
Ana Pozo-Agundo ◽  
Ana María Pérez-Gutiérrez ◽  
José Ignacio Muñoz-Ávila ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Response ◽  
Genetic Variants ◽  
Polypoidal Choroidal Vasculopathy ◽  
Drug Response ◽  
Meta Analysis ◽  
Age Related Macular Degeneration ◽  
Anti Vegf ◽  
Arms2 A69s ◽  
Choroidal Vasculopathy

Polypoidal choroidal vasculopathy (PCV) is usually regarded as a subtype of choroidal neovascularization (CNV) that is secondary to age-related macular degeneration (AMD) characterized by choroidal vessel branching, ending in polypoidal lesions. Despite their close association, PCV and neovascular AMD have shown differences, especially regarding patients’ treatment response. Currently, antivascular endothelial growth factor (anti-VEGF) drugs, such as ranibizumab, bevacizumab and aflibercept, have demonstrated their efficacy in CNV patients. However, in PCV, anti-VEGF treatments have shown inconclusive results. Many genetic polymorphisms have been associated with a variable response in exudative/wet AMD patients. Thus, the aim of this study is to explore the genetic variants affecting anti-VEGF drug response in PCV patients. In this regard, we performed a systematic review and meta-analysis. We found four variants (CFH I62V, CFH Y402H, ARMS2 A69S, and HTRA1-62A/G) that have been significantly related to response. Among them, the ARMS2 A69S variant is assessed in our meta-analysis. In conclusion, in order to implement anti-VEGF pharmacogenetics in clinical routines, further studies should be performed, distinguishing physio-pathogenic circumstances between PCV and exudative AMD and the combined effect on treatment response of different genetic variants.

scholarly journals Combination of half-dose photodynamic therapy and anti-VEGF versus anti-VEGF monotherapy for polypoidal choroidal vasculopathy

2021 ◽  
Vol 3 (3) ◽  
pp. 81-91
Author(s):  
Jun Yong Chow ◽  
Poh Fong She ◽  
Mae-Lynn Catherine Bastion ◽  
Wan Norliza Binti Wan Muda
Keyword(s):  
Photodynamic Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Post Treatment ◽  
Secondary Outcome ◽  
Combination Group ◽  
Monotherapy Group ◽  
Intravitreal Ranibizumab ◽  
Anti Vegf ◽  
Half Dose ◽  
Choroidal Vasculopathy

Introduction: Polypoidal choroidal vasculopathy (PCV) is an abnormality of the inner choroidal vasculature. The recommended treatment for PCV is a combination of standard verteporfin photodynamic therapy (PDT) with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF). There have been reports ofsuccess with combination of half-dose PDT (hd-PDT) and anti-VEGF in the treatment of PCV. hd-PDT might be a cost-effective method with favourable outcome in the treatment of PCV and fewer side effects.Purpose: To explore the efficacy of hd-PDT combined with anti-VEGF and anti-VEGF monotherapy in PCV.Study design: Retrospective nonrandomized comparative study.Material and methods: We conducted a retrospective nonrandomized comparative records review of all patients with PCV received a combination of hd-PDT and anti-VEGF vs anti-VEGF monotherapy from November 2017 to November 2019 at Hospital Tengku Ampuan Afzan, Pahang, Malaysia. Patients received a half-dose of verteporfin over 10 minutes and were irradiated by the standard fluence combined with intravitreal ranibizumab or aflibercept injections. The monotherapy group received either intravitreal ranibizumab or aflibercept. Primary outcome measures were best-corrected visual acuity (BCVA) and central subfield thickness (CST) at 6 months post-treatment. Secondary outcome measure was documentation of sideeffects.Results: The study included a total of 16 patients, with 8 patients (8 eyes) in the combination group and 8 patients (10 eyes) in the monotherapy group. At 6 months post-treatment, the BCVA changes in logarithm of the minimum angle of resolution (logMAR) were -0.06 in the combination group and +0.02 in the monotherapy group (p = 0.928). The average CST reduction was 51.6 μm in the combination group and 106.1 μm in the monotherapy group (p = 0.214). One eye developed subretinal haemorrhage after hd-PDT and one eye developed retinal atrophy in the monotherapy group.Conclusion: hd-PDT combined with anti-VEGF was able to produce similar functional outcomes in terms of BCVA when compared to anti-VEGF monotherapy. However, monotherapy is shown to be superior to combination treatment for anatomical improvement.

scholarly journals Polypoidal Choroidal Vasculopathy Treatment: Photodynamic Therapy, Anti-VEGF Monotherapy or Combination. Review of Clinical Studies

2019 ◽  
Vol 16 (2) ◽  
pp. 151-158
Author(s):  
E. K. Pedanova ◽  
A. V. Doga
Keyword(s):  
Photodynamic Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Randomized Clinical Trials ◽  
Antiangiogenic Therapy ◽  
Age Related Macular Degeneration ◽  
Long Term Results ◽  
Anti Vegf ◽  
Age Related ◽  
Number Of Patients ◽  
Choroidal Vasculopathy

Polypoidal choroidal vasculopathy (PCV) is a rare subtype of neovascular age-related macular degeneration (AMD), its specific features are abnormal branching vascular network with aneurysmal dilatations (polyps), it can be diagnosed in indocyanine green angiography. PCV differs from typical AMD by some ophthalmoscopic manifestations, multimodal imaging data as angiography, OCT with the ability to visualize the choroid, OCT-angiography and expression of VEGF. Despite the different response to antiangiogenic therapy, the presence of pathological neovascularization requires anti-VEGF treatment for both AMD types. In this review, we summarize the latest literature data on the treatment of polyphoidal choroidal vasculopathy: anti-VEGF monotherapy, photodynamic monotherapy, and their combinations. Special attention is paid to the results of multicenter randomized clinical trials with a large number of patients evaluating efficacy of Ranibizumab and Aflibercept (EVEREST 2 and PLANET). The short-term and long-term results of treatment are presented, taking into account the dosing regimens, the number of required injections and the requirement for a combination of anti-VEGF monotherapy with photodynamic therapy. The results of randomized clinical trial are providing high level evidence to guide clinical specialists in choosing the most appropriate therapy for PCV.

scholarly journals The Efficacy of Conbercept in Polypoidal Choroidal Vasculopathy: A Systematic Review

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Yimin Wang ◽  
Mengxi Shen ◽  
Jinwei Cheng ◽  
Xiaodong Sun ◽  
Peter K. Kaiser
Keyword(s):  
Systematic Review ◽  
Polypoidal Choroidal Vasculopathy ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Random Effect ◽  
Fixed Effect Model ◽  
Age Related Macular Degeneration ◽  
Age Related ◽  
Significant Difference ◽  
Choroidal Vasculopathy

Topic. The aim of this study is to evaluate the efficacy of conbercept in PCV, which will optimize the management for PCV patients. Clinical Relevance. The use of antivascular endothelial growth factor (VEGF) therapy in polypoidal choroidal vasculopathy (PCV), a subtype of neovascular age-related macular degeneration (nAMD), has been well established in randomized clinical trials. This meta-analysis has evaluated the efficacy of a novel anti-VEGF agent, conbercept, in the management of PCV using ranibizumab and aflibercept as the reference agents. Methods. Thirty studies with 1308 eyes were identified and included in this study. The primary outcome measures were best-corrected visual acuity (BCVA), and secondary outcomes were optical coherence tomography characteristics and polyp regression rates. The pooled results were calculated by the random-effect or fixed-effect model according to the heterogeneity of the data. Results. Despite a large standard deviation in means (SMD) improvement for BCVA and central retinal thickness (CRT) in the conbercept group, there was no statistically significant difference in the other outcomes compared to ranibizumab and aflibercept. However, there was a greater polyp regression rate in the conbercept group at 12 months. Conclusions. This systematic review indicates that conbercept may achieve similar BCVA and CRT improvements as ranibizumab and aflibercept, with a superior rate of polyp regression at 12 months.

Infographic: Everest II study “Which is superior? Combination therapy or monotherapy for polypoidal choroidal vasculopathy (PCV) treatment”

Eye ◽  
2022 ◽  
Author(s):  
Chinmayi Himanshuroy Vyas ◽  
Pooi Wah Lott ◽  
Rubamalar Gunatheesan ◽  
Shaun Sebastian Sim ◽  
Christopher Ziyu Sun ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Polypoidal Choroidal Vasculopathy ◽  
Choroidal Vasculopathy

Treatment of Ureteral Stent-Related Symptoms

2021 ◽  
pp. 1-16
Author(s):  
Angela Pecoraro ◽  
Dario Peretti ◽  
Zhe Tian ◽  
Roberta Aimar ◽  
Gabriel Niculescu ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
A Priori ◽  
Cumulative Effect ◽  
Risk Difference ◽  
Ureteral Stent ◽  
Pde Inhibitors ◽  
Meta Analyses ◽  
Alpha Antagonist

<b><i>Background:</i></b> The aim of the study was to assess the effectiveness of the main classes of drugs used at reducing morbidity related to ureteric stents. <b><i>Summary:</i></b> After establishing a priori protocol, a systematic electronic literature search was conducted in July 2019. The randomized clinical trials (RCTs) selection proceeded in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and was registered (PROSPERO ID 178130). The risk of bias and the quality assessment of the included RCTs were performed. Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), and quality of life (QoL) were pooled for meta-analysis. Mean difference and risk difference were calculated as appropriate for each outcome to determine the cumulative effect size. Fourteen RCTs were included in the analysis accounting for 2,842 patients. Alpha antagonist, antimuscarinic, and phosphodiesterase (PDE) inhibitors significatively reduced all indexes of the USSQ, the IPSS and QoL scores relative to placebo. Conversely, combination therapy (alpha antagonist plus antimuscarinic) showed in all indexes of the USSQ, IPSS, and QoL over alpha antagonist or antimuscarinic alone. On comparison with alpha blockers, PDE inhibitors were found to be equally effective for urinary symptoms, general health, and body pain parameters, but sexual health parameters improved significantly with PDE inhibitors. Finally, antimuscarinic resulted in higher decrease in all indexes of the USSQ, the IPSS, and QoL relative to alpha antagonist. <b><i>Key message:</i></b> Relative to placebo, alpha antagonist alone, antimuscarinics alone, and PDE inhibitors alone have beneficial effect in reducing stent-related symptoms. Furthermore, there are significant advantages of combination therapy compared with monotherapy. Finally, PDE inhibitors are comparable to alpha antagonist, and antimuscarinic seems to be more effective than alpha antagonist alone.

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