Different approaches for treating myopic choroidal neovascularization: a network Meta-analysis

Area of Science:

• Ophthalmology
• Retinal Diseases
• Medical Treatments

Background:

• Myopic choroidal neovascularization (mCNV) is a leading cause of vision loss in high myopia.
• Treatment options for mCNV include anti-vascular endothelial growth factor (anti-VEGF) therapy, photodynamic therapy (PDT), and laser treatment (LT).
• Evaluating the comparative efficacy of these treatments is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the efficacy of intravitreal anti-VEGF agents, PDT, and LT in improving visual acuity and retinal thickness in patients with mCNV.
• To assess the impact of these treatments on secondary outcomes such as chorioretinal atrophy (CRA).

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, Cochrane Library, Web of Science) up to January 30, 2023.
• Studies comparing best-corrected visual acuity (BCVA) and foveal center thickness (FCT) changes post-treatment were included.
• Chorioretinal atrophy (CRA) was analyzed as a secondary outcome measure.

Main Results:

• Intravitreal bevacizumab (IVB) and ranibizumab (IVR) demonstrated superior BCVA improvement compared to PDT in randomized controlled trials (RCTs).
• The relative effectiveness for BCVA improvement was generally IVR > intravitreal aflibercept (IVA) > IVB > LT > PDT.
• For FCT improvement, the order was IVA > IVR > IVB > PDT, with similar trends observed in retrospective studies.

Conclusions:

• Anti-VEGF therapies, particularly intravitreal injections, are most effective for long-term vision improvement in mCNV.
• Monotherapy with IVB or IVR may be more beneficial than combination therapy with PDT for mCNV.
• No significant differences were found in visual acuity, macular edema, or CRA improvement among different anti-VEGF drugs.