Evaluating photodynamic therapy as an adjuvant treatment for neovascular AMD: A comprehensive meta-analysis

Abstract

Purpose: This study aimed to assess the role of photodynamic therapy (PDT) as an adjunct to anti-vascular endothelial growth factor (Anti-VEGF) intravitreal injections in the treatment of neovascular age-related macular degeneration (nvAMD).

Methods: PubMed, Cochrane Library, and ClinicalTrials.gov were searched for keywords "macular degeneration" and "photodynamic therapy" and "placebo" or "ranibizumab" or "bevacizumab" or "aflibercept" from inception to 2023. Included studies were peer-reviewed primary data reporting 12-month treatment results of nvAMD with anti-VEGF and PDT, anti-VEGF alone, intravitreal triamcinolone, or placebo. 23 studies were included in the final analysis. The major outcomes were best-corrected visual acuity (BCVA), central retinal thickness (CRT), and injection burden at 12 months.

Results: Anti-VEGF + PDT had better BCVA at 12 months compared to anti-VEGF (MD -0.07; 95 % CI -0.12, -0.01; P = 0.02). There was no significant difference in CRT at 12 months in anti-VEGF + PDT group versus anti-VEGF (MD -3.66; 95 % CI -10.28, 2.98; P = 0.28). Anti-VEGF + PDT group had significantly fewer injections compared to anti-VEGF (MD -1.76; 95 % CI -1.95, -1.58; P < 0.0001). There was no significant difference in pooled ocular adverse events between anti-VEGF + PDT versus anti-VEGF (MD 0.96; 95 % CI 0.68, 1.36; P = 0.41).

Conclusions: PDT is a successful adjunctive to anti-VEGF injections for the treatment of nvAMD. The combination of the therapies leads to improved BCVA at 12 months, decreased injection burden, and no difference in ocular safety.

Keywords: Anti-VEGF; Best corrected visual acuity; Intravitreal injection; Neovascular age-related macular degeneration; Photodynamic therapy; Vitreoretinal disease.