Skip to main content

Advertisement

SpringerLink
Log in

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

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To estimate the polyp regression rate and treatment prognosis of different interventions for polypoidal choroidal vasculopathy (PCV) and clarify its baseline characteristics.

Methods

The PubMed, EMBASE, and Ovid were searched up to January 2020 to identify related studies. R software version 3.6.3 was used to perform the statistical analyses. Results in proportion with 95% confidence interval (CI) were calculated by means of the Freeman-Tukey variant of arcsine square transformation. Chi-squared test and I2 statistics were used to evaluate the statistical heterogeneity. Sensitivity analysis and subgroup analyses were performed to identify the source of heterogeneity.

Results

This meta-analysis included 104 studies with 5816 patients. The pooling results indicated the general rate of complete polyp regression at post-treatment 12 months was 64% (95% CI [57~71%]), 89% (95% CI [81~95%]) for photodynamic therapy (PDT) monotherapy, 78% (95% CI [68~86%]) for PDT plus anti-vascular endothelial growth factor (anti-VEGF), and 42% (95% CI [35~49%]) for anti-VEGF monotherapy; PDT plus anti-VEGF showed the best efficacy in visual improvement and achieved the highest rate of dry macula (91%, 95% CI [78~99%]), while anti-VEGF monotherapy achieved the lowest polyp recurrence rate (14%, 95% CI [8~20%]); PDT monotherapy showed the best efficacy in pigment epithelial detachment regression (66%, 95% CI [58~83%]). Additionally, the baseline characteristics of PCV were also well described.

Conclusion

PDT plus anti-VEGF is still valuable for the management of PCV; it could achieve not only satisfactory anatomical outcomes like dry macula rate and polyp regression rate but also ideal visual prognosis like BCVA improvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

Anti-VEGF:

Anti-vascular endothelial growth factor

BCVA:

Best-corrected visual acuity

BVN:

Branching vascular network

CI:

Confidence interval

ICGA:

Indocyanine green angiography

IRF:

Intraretinal fluid

nAMD:

Neovascular age-related macular degeneration

PCV:

Polypoidal choroidal vasculopathy

PDT:

Photodynamic therapy

PED:

Pigment epithelial detachment

PRN:

Pro re nata

RCT:

Randomized controlled trial

RPE:

Retinal pigment epithelial

SRF:

Subretinal fluid

SRH:

Subretinal hemorrhage

TLP:

Thermal laser photocoagulation

T&E:

Treat-and-extend

References

  1. Cheung CMG, Lai TYY, Ruamviboonsuk P, Chen SJ, Chen YX, Freund KB, Gomi F, Koh AH, Lee WK, Wong TY (2018) Polypoidal choroidal vasculopathy: definition, pathogenesis, diagnosis, and management. Ophthalmology 125(5):708–724

    Article  Google Scholar 

  2. Koh AH, Expert PCV Panel, Chen LJ, Chen SJ, Chen YX, Giridhar A, Iida T, Kim H, Lai TYY, Lee KW, Li XX, Lim TH, Ruamviboonsuk P, Sharma T, Tang S, Yuzawa M (2013) Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment. Retina 33(4):686–716

    Article  Google Scholar 

  3. Gu X, Yu X, Dai H (2019) Therapeutic effects of ranibizumab in patients with polypoidal choroidal vasculopathy. BMC Ophthalmol 19(1):153

    Article  Google Scholar 

  4. Wong CW, Wong TY, Cheung CM (2015) Polypoidal choroidal vasculopathy in Asians. J Clin Med 4(5):782–821

    Article  CAS  Google Scholar 

  5. Teo KYC, Gillies M, Fraser-Bell S(2018) The Use of Vascular Endothelial Growth Factor Inhibitors and Complementary Treatment Options in Polypoidal Choroidal Vasculopathy: A Subtype of Neovascular Age-Related Macular Degeneration. Int J Mol Sci 19(9):2611

  6. Kang HM, Koh HJ (2014) Two-year outcome after combination therapy for polypoidal choroidal vasculopathy: comparison with photodynamic monotherapy and anti-vascular endothelial growth factor monotherapy. Ophthalmologica 231(2):86–93

    Article  CAS  Google Scholar 

  7. Kang HM, Koh HJ, Lee CS (2014) Combined photodynamic therapy with intravitreal bevacizumab injections for polypoidal choroidal vasculopathy: long-term visual outcome. Am J Ophthalmol 157(3):598–606.e1

    Article  CAS  Google Scholar 

  8. Wong TY, Ogura Y, Lee WK, Iida T, Chen SJ, Mitchell P, Cheung CMG, Zhang ZQ, Leal S, Ishibashi T, Investigators P (2019) Efficacy and safety of intravitreal aflibercept for polypoidal choroidal vasculopathy: two-year results of the Aflibercept in Polypoidal Choroidal Vasculopathy Study. Am J Ophthalmol 204:80–89

    Article  CAS  Google Scholar 

  9. Lee WK, Iida T, Ogura Y, Chen SJ, Wong TY, Mitchell T, Cheung GCM, Zhang Z, Leal S, Ishibashi T, PLANET Investigators (2018) Efficacy and safety of intravitreal aflibercept for polypoidal choroidal vasculopathy in the PLANET study: a randomized clinical trial. JAMA Ophthalmol 136(7):786–793

    Article  Google Scholar 

  10. Koh A, Lai TYY, Takahashi K, Wong TY, Chen LJ, Ruamviboonsuk P, Tan CS, Feller C, Margaron P, Lim TH, Lee WK, EVEREST II study group (2017) Efficacy and safety of Ranibizumab with or without Verteporfin photodynamic therapy for polypoidal choroidal vasculopathy: a randomized clinical trial. JAMA Ophthalmol 135(11):1206–1213

    Article  Google Scholar 

  11. Gomi F, Oshima Y, Mori R, Kano M, Saito M, Yamashita A, Iwata E, Maruko R, Fujisan Study Group (2015) Initial versus delayed photodynamic therapy in combination with ranibizumab for treatment of polypoidal choroidal vasculopathy: the Fujisan study. Retina 35(8):1569–1576

    Article  CAS  Google Scholar 

  12. Koh A, Lee WK, Chen LJ, Chen SJ, Hashad Y, Kim H, Lai TY, Pilz S, Ruamviboonsuk P, Tokaji E, Weisberger A, Lim TH (2012) EVEREST study: efficacy and safety of verteporfin photodynamic therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in patients with symptomatic macular polypoidal choroidal vasculopathy. Retina 32(8):1453–1464

    Article  CAS  Google Scholar 

  13. Cho HJ, Baek JS, Lee DW, Cho SW, Kim CG, Kim JW (2013) Effects of vitreomacular adhesion on anti-vascular endothelial growth factor treatment for polypoidal choroidal vasculopathy. Retina 33(10):2126–2132

    Article  CAS  Google Scholar 

  14. Hikichi T, Higuchi M, Matsushita T, Kosaka S, Matsushita R, Takami T, Ohtsuka H, Kitamei H, Shioya S (2013) Results of 2 years of treatment with as-needed ranibizumab reinjection for polypoidal choroidal vasculopathy. Br J Ophthalmol 97(5):617–621

    Article  Google Scholar 

  15. Yamashita A, Shiraga F, Shiragami C, Shirakata Y, Fujiwara A (2013) Two-year results of reduced-fluence photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol 155(1):96–102.e1

    Article  Google Scholar 

  16. Lee WK, Kim KS, Kim W, Lee SB, Jeon S (2012) Responses to photodynamic therapy in patients with polypoidal choroidal vasculopathy consisting of polyps resembling grape clusters. Am J Ophthalmol 154(2):355–365.e1

    Article  Google Scholar 

  17. Hikichi T, Higuchi M, Matsushita T, Kosaka S, Matsushita R, Takami K, Ohtsuka H, Ariga H (2012) One-year results of three monthly ranibizumab injections and as-needed reinjections for polypoidal choroidal vasculopathy in Japanese patients. Am J Ophthalmol 154(1):117–124.e1

    Article  CAS  Google Scholar 

  18. Ricci F, Calabrese A, Regine F, Missiroli F, Ciardella AP (2012) Combined reduced fluence photodynamic therapy and intravitreal ranibizumab for polypoidal choroidal vasculopathy. Retina 32(7):1280–1288

    Article  CAS  Google Scholar 

  19. Cho JH, Park YJ, Cho SC, Ryoo NK, Cho KH, Park SJ, Park KH, Woo SJ (2020) Posttreatment polyp regression and risk of massive submacular hemorrhage in eyes with polypoidal choroidal vasculopathy. Retina 40(3):468–476

    Article  CAS  Google Scholar 

  20. Doble B, Finkelstein EA, Tian Y, Saxena N, Patil S, Wong TY, Cheung CMG (2020) Cost-effectiveness of intravitreal ranibizumab with verteporfin photodynamic therapy compared with ranibizumab monotherapy for patients with polypoidal choroidal vasculopathy. JAMA Ophthalmol 138(3):251–259

    Article  Google Scholar 

  21. Quaranta M, Mauget-Faÿsse M, Coscas G (2002) Exudative idiopathic polypoidal choroidal vasculopathy and photodynamic therapy with verteporfin. Am J Ophthalmol 134(2):277–280

    Article  Google Scholar 

  22. Ho M, Lo EC, Young AL, Liu DT (2014) Outcome of polypoidal choroidal vasculopathy at 1 year by combined therapy of photodynamic therapy with ranibizumab and predictive factors governing the outcome. Eye (Lond) 28(12):1469–1476

    Article  CAS  Google Scholar 

  23. Weng HY, Huang TL, Chang PY, Wang JK (2019) One-year outcome of combination therapy with intravitreal aflibercept and photodynamic therapy for polypoidal choroidal vasculopathy. BMC Pharmacol Toxicol 20(1):29

    Article  Google Scholar 

  24. Qian T, Li X, Zhao M, Xu X (2018) Polypoidal choroidal vasculopathy treatment options: a meta-analysis. Eur J Clin Investig 48(1):e12840

    Article  Google Scholar 

  25. Wang W, He M, Zhang X (2014) Combined intravitreal anti-VEGF and photodynamic therapy versus photodynamic monotherapy for polypoidal choroidal vasculopathy: a systematic review and meta-analysis of comparative studies. PLoS One 9(10):e110667

    Article  Google Scholar 

  26. Rogers AH, Greenberg PB, Martidis A, Puliafito CA (2003) Photodynamic therapy of polypoidal choroidal vasculopathy. Ophthalmic Surg Lasers Imaging 34(1):60–63

    Article  Google Scholar 

  27. Torrón Fernández-Blanco C, Pérez Oliván S, Ferrer Novella E, Ruiz-Moreno O, Marcuello Melendo B, Honrubia López FM (2003) Photodynamic therapy for choroidal neovascularization not caused by age related macular degeneration or pathologic myopia. Arch Soc Esp Oftalmol 78(9):471–476

    Article  Google Scholar 

  28. Tock HL, Timothy YYL, Kanji T, Tien YW, Lee-Jen C, Paisan R, Colin ST, KiL W, Chui MGC, Nor FN, Ramune P, Philippe M, Adrian K, EVEREST II Study Group (2020) Comparison of ranibizumab with or without Verteporfin photodynamic therapy for polypoidal choroidal vasculopathy: the EVEREST II Randomized Clinical Trial. JAMA Ophthalmol 138(9):935–942

    Article  Google Scholar 

  29. Laude A, Cackett PD, Vithana EN, Yeo IY, Wong D, Koh AH, Wong TY, Aung T (2010) Polypoidal choroidal vasculopathy and neovascular age-related macular degeneration: same or different disease? Prog Retin Eye Res 29(1):19–29

    Article  Google Scholar 

  30. Kauppinen A (2020) Introduction to the multi-author review on macular degeneration. Cell Mol Life Sci 77(5):779–780

    Article  CAS  Google Scholar 

Download references

Acknowledgments

Xin-yu Zhao wants to thank, in particular, the invaluable support received from Shengzhi Liu over the years.

Author information

Author notes

  1. Xin-yu Zhao and Wen-fei Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Xin-yu Zhao, Wen-fei Zhang, Li-hui Meng, Dong-yue Wang & You-xin Chen

  2. Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

    Xin-yu Zhao, Wen-fei Zhang, Li-hui Meng, Dong-yue Wang & You-xin Chen

Authors
  1. Xin-yu Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wen-fei Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Li-hui Meng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dong-yue Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. You-xin Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Xin-yu Zhao conceived this study and made a contribution to analyzing the data and revising the manuscript. Wen-fei Zhang carried out the literature search and data extraction and wrote the draft of the manuscript. Li-hui Meng and Dong-yue Wang assisted in the draft. You-xin Chen conducted and coordinated the whole process. All authors have read the final manuscript and reached an agreement.

Corresponding author

Correspondence to You-xin Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Not applicable.

Additional information

Statement of non-duplication

We certify that this manuscript is a unique submission and is not being considered for publication by any other source in any medium. Furthermore, the manuscript has not been published, in part or in full, in any form.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 29 kb).

ESM 2

(DOCX 48 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhao, Xy., Zhang, Wf., Meng, Lh. et al. The polyp regression rate and treatment prognosis of different interventions for polypoidal choroidal vasculopathy: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 259, 855–872 (2021). https://doi.org/10.1007/s00417-020-04977-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-020-04977-1

Keywords

Search

Navigation