Different approaches for the treatment of myopic choroidal neovascular: a network meta-analysis

Abstract Purpose: In order to evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs, photodynamic therapy (PDT), and laser treatment (LT) for anatomical and functional improvement in myopic choroidal neovascularization (mCNV) patients were evaluated in a mesh meta-analysis. Methods: Two researchers independently searched PubMed, Cochrane Library, Web of Science, CNKI, WanFang Data, Embase, and other databases to screen RCTs and retrospective studies comparing best-corrected visual acuity (BCVA) and foveal center thickness (FCT) changes after mCNV treatment. The retrieval time limit is from the database construction to November 30, 2021. ADDIS1.16.8 and R 3.5.3 software were used to conduct mesh meta-analyses of RCTs and retrospective studies, respectively. Results: A total of 601 eyes in 8 RCTs involving 6 treatment options: intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR), intravitreal conbercept (IVC), intravitreal aflibercept (IVA), LT, PDT, sham first followed by IVA (Sham /IVA). The results of the mesh meta-analysis showed that: in the RCTs, IVB and IVR were superior to PDT [MD=0.18, 95%CI (0.01, 0.42)] in improving BCVA of mCNV patients, and all the therapeutic effects from high to low might be intravitreal IVA, IVB, IVR, LT, Sham/IVA, and PDT; the order of FCT thickness reduction from high to low is IVA, IVR, IVB, PDT. In addition, the results of BCVA after long-term treatment in retrospective studies showed that all the therapeutic effects from high to low might be IVA, IVC, IVB /IVR, IVB, IVR, PDT, PDT with IVB /IVR; as for the order of FCT thickness reduction from high to low is IVA, IVC, IVR, IVB, PDT. Conclusions: Anti-VEGF treatment in patients with long-term improvement in mCNV vision effect is best, using IVB or IVR alone to treat mCNV may be better than IVB or IVR combined with PDT; There was no significant difference in the improvement of visual acuity and macular edema in mCNV patients with different anti-VEGF drugs. Due to the limited number and quality of included literature, the above conclusions need to be confirmed by more large-sample and high-quality articles.