Anti-vascular endothelial growth factor monotherapy or combined with verteporfin photodynamic therapy for retinal angiomatous proliferation: a systematic review with meta-analysis

Matteo Fallico; Iacopo Macchi; Andrea Maugeri; Giuliana Favara; Martina Barchitta; Roberta Magnano San Lio; Antonella Agodi; Andrea Russo; Antonio Longo; Teresio Avitabile; Niccolò Castellino; Michele Reibaldi; Francesco Pignatelli; Maria Vadalà; Clara Patanè; Marcella Nebbioso; Vincenza Bonfiglio

doi:10.3389/fphar.2023.1141077

Anti-vascular endothelial growth factor monotherapy or combined with verteporfin photodynamic therapy for retinal angiomatous proliferation: a systematic review with meta-analysis

Front Pharmacol. 2023 Jun 12:14:1141077. doi: 10.3389/fphar.2023.1141077. eCollection 2023.

Authors

Matteo Fallico¹, Iacopo Macchi², Andrea Maugeri³, Giuliana Favara³, Martina Barchitta³, Roberta Magnano San Lio³, Antonella Agodi³, Andrea Russo¹, Antonio Longo¹, Teresio Avitabile¹, Niccolò Castellino¹, Michele Reibaldi⁴, Francesco Pignatelli⁵, Maria Vadalà⁶, Clara Patanè⁶, Marcella Nebbioso⁷, Vincenza Bonfiglio⁶

Affiliations

¹ Department of Ophthalmology, University of Catania, Catania, Italy.
² Newcastle Eye Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom.
³ Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy.
⁴ Department of Surgical Sciences, Eye Clinic Section, University of Turin, Turin, Italy.
⁵ Eye Clinic, Hospital "SS Annunziata", ASL Taranto, Taranto, Italy.
⁶ Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, Palermo, Italy.
⁷ Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy.

Abstract

Purpose: To assess functional and anatomical outcomes of intravitreal anti-Vascular Endothelial Growth Factor (anti-VEGF) monotherapy versus combined with verteporfin Photodynamic Therapy (PDT) for Retinal Angiomatous Proliferation (RAP). Methods: Studies reporting outcomes of intravitreal anti-VEGF monotherapy and/or in combination with verteporfin PDT in RAP eyes with a follow-up ≥ 12 months were searched. The primary outcome was the mean change in best corrected visual acuity (BCVA) at 12 months. Mean change in central macular thickness (CMT) and mean number of injections were considered as secondary outcomes. The mean difference (MD) between pre- and post-treatment values was calculated along with 95% Confidence Interval (95% CI). Meta-regressions were performed to assess the influence of anti-VEGF number of injections on BCVA and CMT outcomes. Results: Thirty-four studies were included. A mean gain of 5.16 letters (95% CI = 3.30-7.01) and 10.38 letters (95% CI = 8.02-12.75) was shown in the anti-VEGF group and combined group, respectively (anti-VEGF group vs. combined group, p < 0.01). A mean CMT reduction of 132.45 µm (95% CI = from -154.99 to -109.90) and 213.93 µm (95% CI = from -280.04 to -147.83) was shown in the anti-VEGF group and combined group, respectively (anti-VEGF group vs. combined group, p < 0.02). A mean of 4.9 injections (95% CI = 4.2-5.6) and 2.8 injections (95% CI = 1.3-4.4) were administered over a 12-month period in the anti-VEGF group and combined group, respectively. Meta-regression analyses showed no influence of injection number on visual and CMT outcomes. High heterogeneity was found across studies for both functional and anatomical outcomes. Conclusion: A combined approach with anti-VEGF and PDT could provide better functional and anatomical outcomes in RAP eyes compared with anti-VEGF monotherapy.

Keywords: anti vascular endothelial growth factor; combined therapy; monotherapy; retinal angiomatous proliferation (RAP); verteporfin photodynamic therapy (V-PDT).

Publication types

Systematic Review