The polyp regression rate and treatment prognosis of different interventions for polypoidal choroidal vasculopathy: a systematic review and meta-analysis

Enhancing anti-vascular endothelial growth factor with photodynamic therapy for polypoidal choroidal vasculopathy: A meta-analysis

Anti-vascular endothelial growth factor (anti-VEGF) agents administered as either monotherapy or combination with verteporfin photodynamic therapy (PDT) are the 2 dominant treatment for polypoidal choroidal vasculopathy (PCV); however, controversies remain due to small sample sizes and inconsistency in prognosis from randomized controlled trials (RCTs). In accordance with the PRISMA statement, we investigated the efficacy of PDT plus anti-VEGF combination with anti-VEGF monotherapy. This study was accepted by the International Prospective Register of Systematic Reviews (CRD42023471362). Studies published up to July, 2024, were retrieved from PubMed, Embase, and Cochrane databases. A total of 7 RCTs with 926 eyes were reviewed. In 6 trials, combination therapy showed significantly higher rate of complete polyp regression (risk ratio [RR]: 1.56, 95 % CI: 1.15-2.13, p = 0.005). In 5 trials, combination therapy also significantly reduced the number of anti-VEGF injections (SMD: -0.65, 95 % CI: -0.95 to -0.35, p < 0.0001). For best corrected visual acuity improvement, central retinal thickness reduction, and rate of ocular adverse events, the performance of the 2 modalities were comparable. We conclude that PDT plus anti-VEGF combination therapy constitutes a safe and effective modality and should be considered the first-line treatment for PCV.

Exploring and identifying the imaging biomarkers for predicting anti-VEGF treatment response in polypoidal choroidal vasculopathy: a prospective multicenter study

BACKGROUND

Polypoidal choroidal vasculopathy (PCV) is a hemorrhagic fundus disease that can lead to permanent vision loss. Predicting the treatment response to anti-VEGF monotherapy in PCV is consistently challenging. We aimed to conduct a prospective multicenter study to explore and identify the imaging biomarkers for predicting the anti-VEGF treatment response in PCV patients, establish predictive model, and undergo multicenter validation.

METHODS

This prospective multicenter study utilized clinical characteristics and images of treatment naïve PCV patients from 15 ophthalmic centers nationwide to screen biomarkers, develop model, and validate its performance. Patients from Peking Union Medical College Hospital were randomly divided into a training set and an internal validation set. A nomogram was established by univariate, LASSO regression, and multivariate regression analysis. Patients from the other 14 centers served as an external test set. Area under the curve (AUC), sensitivity, specificity, and accuracy were calculated. Decision curve analysis (DCA) and clinical impact curve (CIC) were utilized to evaluate the practical utility in clinical decision-making.

FINDINGS

The eye distribution for the training set, internal validation set, and external test set were 66, 31, and 71, respectively. The 'Good responder' exhibited a thinner subfoveal choroidal thickness (SFCT) (230.67 ± 61.96 vs. 314.42 ± 88.00 μm, p < 0.001), lower choroidal vascularity index (CVI) (0.31 ± 0.08 vs. 0.36 ± 0.05, p = 0.006), fewer choroidal vascular hyperpermeability (CVH) (31.0 vs. 62.2%, p = 0.012), and more intraretinal fluid (IRF) (58.6 vs. 29.7%, p = 0.018). SFCT (OR 0.990; 95% CI 0.981-0.999; p = 0.033) and CVI (OR 0.844; 95% CI 0.732-0.971; p = 0.018) were ultimately included as the optimal predictive biomarkers and presented in the form of a nomogram. The model demonstrated AUC of 0.837 (95% CI 0.738-0.936), 0.891 (95% CI 0.765-1.000), and 0.901 (95% CI 0.824-0.978) for predicting 'Good responder' in the training set, internal validation set, and external test set, respectively, with excellent sensitivity, specificity, and practical utility.

INTERPRETATION

Thinner SFCT and lower CVI can serve as imaging biomarkers for predicting good treatment response to anti-VEGF monotherapy in PCV patients. The nomogram based on these biomarkers exhibited satisfactory performances.