Meta-analysis of photodynamic therapy and intravitreal injection of anti-vascular endothelial growth factor agent in the treatment of polypoid choroidal vasculopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

YangJingyuan , WangErxi ,  ChenYouxin

Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China;

Corresponding author：

ChenYouxin, Email: chenyouxinpumch@163.com

Keywords：

Choroid diseases/therapy; Angiogenesis inhibitors/therapeutic use; Photochemotherapy; Antibodies, monoclonal/therapeutic use; Meta-analysis

DOI：

10.3760/cma.j.issn.1005-1015.2016.01.018

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the efficacy and safety of photodynamic therapy (PDT) and intravitreal vascular endothelial growth factor (VEGF) inhibitors in the treatment of polypoidal choroidal vasculopathy (PCV), and to investigate the primary treatment tentatively. Methods A systematic search of Pubmed, Embase, the Cochrane Library and the Wanfang Data was performed to identify all comparative studies that compared the outcomes of PDT alone, intravitreal VEGF inhibitors alone and combined intravitreal VEGF inhibitors and photodynamic therapy. Outcomes of interest included the regression and recurrence rate of polypoidal lesions, best corrected visual acuity (BCVA), central retinal thickness (CRT), therapeutic times, and the occurrence rate of adverse events. 2 randomized controlled trials (RCT) and 19 non-RTCs were identified. According to treatment methods, the data extracted was classified to 3 groups, analyzed with odds ratio (OR), weighted mean difference (WMD) and 95%confidence interval (95%CI). Results Meta-analysis suggests that the regression rate of polypoidal lesions (OR=0.34, 0.07; 95%CI=0.13-0.88, 0.02-0.36) and BCVA (WMD=0.25, 0.11; 95%CI=0.14-0.36, 0.01-0.21) in combined therapy group were significantly better than those in PDT group and intravitreal VEGF inhibitors group (P < 0.05). The recurrence rate of polypoidal lesions in PDT group was significantly lower than intravitreal VEGF inhibitors group (OR=0.35, 95%CI=0.16-0.74, P=0.006). BCVA (P=0.025) and the occurrence rate of adverse events (OR=60.36, 95%CI=6.04-603.50, P=0.000 5) in intravitreal VEGF inhibitors group were significant better than PDT group. Conclusions Combined treatment appeared to be superior to PDT alone or intravitreal VEGF inhibitors alone. Combined treatment takes priority over all others in the primary treatment of PCV.

Citation： YangJingyuan, WangErxi, ChenYouxin. Meta-analysis of photodynamic therapy and intravitreal injection of anti-vascular endothelial growth factor agent in the treatment of polypoid choroidal vasculopathy. Chinese Journal of Ocular Fundus Diseases, 2016, 32(1): 73-78. doi: 10.3760/cma.j.issn.1005-1015.2016.01.018 Copy

1.	Koh AH, Chen LJ, Chen SJ, et al. Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment[J]. Retina, 2013, 33(4):686-716. DOI:10.1097/IAE.0b013e3182852446.
2.	Leal S, Silva R, Figueira J, et al. Photodynamic therapy with verteporfin in polypoidal choroidal vasculopathy: results after 3 years of follow-up[J]. Retina, 2010, 30(8):1197-1205. DOI: 10.1097/IAE.0b013e3181d37486.
3.	Akaza E, Yuzawa M, Mori R. Three-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy[J]. Jpn J Ophthalmol, 2011, 55(1):39-44. DOI: 10.1007/s10384-010-0886-x.
4.	Michels S, Schmidt-Erfurth U. Sequence of early vascular events after photodynamic therapy[J]. Invest Ophthalmol Vis Sci, 2003, 44(5):2147-2154.
5.	Schlotzer-Schrehardt U, Viestenz A, Naumann GO, et al. Dose-related structural effects of photodynamic therapy on choroidal and retinal structures of human eyes[J]. Graefe's Arch Clin Exp Ophthalmol, 2002, 240(9):748-757.
6.	Schmidt-Erfurth U, Schlotzer-Schrehard U, Cursiefen C, et al. Influence of photodynamic therapy on expression of vascular endothelial growth factor (VEGF), VEGF receptor 3, and pigment epithelium-derived factor[J]. Invest Ophthalmol Vis Sci, 2003, 44(10):4473-4480.
7.	Alshahrani ST, Al SH, Kahtani ES, et al. Spectral-domain optical coherence tomography findings in polypoidal choroidal vasculopathy suggest a typeⅠneovascular growth pattern[J]. Clin Ophthalmol, 2014, 8:1689-1695. DOI: 10.2147/OPTH.S68471.
8.	Kokame GT. Polypoidal choroidal vasculopathy-a typeⅠpolypoidal subretinal neovasculopathy[J]. Open Ophthalmol J, 2013, 7:82-84.DOI: 10.2174/1874364101307010082.
9.	Matsuoka M, Ogata N, Otsuji T, et al. Expression of pigment epithelium derived factor and vascular endothelial growth factor in choroidal neovascular membranes and polypoidal choroidal vasculopathy[J]. Br J Ophthalmol, 2004, 88(6):809-815. DOI: 10.2174/1874364101307010082.
10.	Tong J P, Chan WM, Liu DT, et al. Aqueous humor levels of vascular endothelial growth factor and pigment epithelium-derived factor in polypoidal choroidal vasculopathy and choroidal neovascularization[J]. Am J Ophthalmol, 2006, 141(3): 456-462.
11.	Wong CW, Wong TY, Cheung CM. Polypoidal choroidal vasculopathy in Asians[J]. J Clin Med, 2015, 4(5):782-821. DOI: 10.3390/jcm4050782.
12.	O'Connor D, Green S, Higgins JPT, et al. Part 2:General methods for Cochrane reviews[M]//Julian Pt Higgins SG. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration, 2011. http://handbook.cochrane.org.
13.	Reeves BC, Deeks JJ, Higgins JPT, et al. Part 3:Special topics[M]//Julian Pt Higgins SG. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration, 2011. http://handbook.cochrane.org.
14.	Koh A, Lee WK, Chen LJ, et al. 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[J]. Retina, 2012, 32(8):1453-1464.DOI:10.1097/IAE.0b013e31824f91e8.
15.	Oishi A, Kojima H, Mandai M, et al. Comparison of the effect of ranibizumab and verteporfin for polypoidal choroidal vasculopathy: 12-month LAPTOP study results[J]. Am J Ophthalmol, 2013, 156(4):644-651. DOI: 10.1016/j.ajo.2013.05.024.
16.	Oishi A, Miyamoto N, Mandai M, et al. LAPTOP study: a 24-month trial of verteporfin versus ranibizumab for polypoidal choroidal vasculopathy[J]. Ophthalmology, 2014, 121(5):1151-1152. DOI: 10.1016/j.ophtha.2013.12.037.
17.	Lai TY, Lee GK, Luk FO, et al. Intravitreal ranibizumab with or without photodynamic therapy for the treatment of symptomatic polypoidal choroidal vasculopathy[J]. Retina, 2011, 31(8):1581-1588. DOI: 10.1097/IAE.0b013e31820d3f3f.
18.	Kang HM, Koh HJ. Two-year outcome after combination therapy for polypoidal choroidal vasculopathy: comparison with photodynamic monotherapy and anti-vascular endothelial growth factor monotherapy[J]. Ophthalmologica, 2014, 231(2):86-93. DOI: 10.1159/000354546.
19.	Mitamura Y, Kitahashi M, Kubota-Taniai M, et al. Comparison of intravitreal bevacizumab to photodynamic therapy for polypoidal choroidal vasculopathy: short-term results[J]. Indian J Ophthalmol, 2010, 58(4):291-296. DOI: 10.4103/0301-4738.64130.
20.	Saito M, Iida T, Kano M. Intravitreal ranibizumab for polypoidal choroidal vasculopathy with recurrent or residual exudation[J]. Retina, 2011, 31(8): 1589-1597.DOI: 10.1097/IAE.0b013e31820f4b21.
21.	Rouvas AA, Papakostas TD, Ntouraki A, et al. Photodynamic therapy, ranibizumab, and ranibizumab with photodynamic therapy for the treatment of polypoidal choroidal vasculopathy[J]. Retina, 2011, 31(3):464-474. DOI: 10.1097/IAE.0b013e3181f274ec.
22.	Inoue M, Arakawa A, Yamane S, et al. Long-term outcome of intravitreal ranibizumab treatment, compared with photodynamic therapy, in patients with polypoidal choroidal vasculopathy[J]. Eye (Lond), 2013, 27(9):1013-1020, 1021. DOI: 10.1038/eye.2013.179.
23.	Kim SJ, Yu HG. Efficacy of combined photodynamic therapy and intravitreal bevacizumab injection versus photodynamic therapy alone in polypoidal choroidal vasculopathy[J]. Retina, 2011, 31(9):1827-1834. DOI: 10.1097/IAE.0b013e318214d01e.
24.	Gomi F, Sawa M, Wakabayashi T, et al. Efficacy of intravitreal bevacizumab combined with photodynamic therapy for polypoidal choroidal vasculopathy[J]. Am J Ophthalmol, 2010, 150(1):48-54. DOI: 10.1016/j.ajo.2010.02.008.
25.	Lee YA, Yang CH, Yang CM, et al. Photodynamic therapy with or without intravitreal bevacizumab for polypoidal choroidal vasculopathy: two years of follow-up[J]. Am J Ophthalmol, 2012, 154(5):872-880. DOI: 10.1016/j.ajo.2012.03.051.
26.	Maruko I, Iida T, Sugano Y, et al. Subfoveal retinal and choroidal thickness after verteporfin photodynamic therapy for polypoidal choroidal vasculopathy[J]. Am J Ophthalmol, 2011, 151(4):594-603. DOI: 10.1016/j.ajo.2010.10.030.
27.	Saito M, Iida T, Kano M, et al. Two-year results of combined intravitreal ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(9):2099-2110. DOI: 10.1007/s00417-013-2323-6.
28.	Sakurada Y, Iijima H. Two-year results of photodynamic therapy with or without intravitreal ranibizumab for polypoidal choroidal vasculopathy[J]. J Ocul Pharmacol Ther, 2013, 29(9):832-836. DOI: 10.1089/jop.2013.0044.
29.	Nakata I, Tsujikawa A, Yamashiro K, et al. Two-year outcome of photodynamic therapy combined with intravitreal injection of bevacizumab and triamcinolone acetonide for polypoidal choroidal vasculopathy[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(4):1073-1080. DOI:10.1007/s00417-012-2137-y.
30.	Song MH, Ryu HW, Roh YJ. One-year results of intravitreal ranibizumab with or without photodynamic therapy for polypoidal choroidal vasculopathy[J]. Ophthalmologica, 2011, 226(3):119-126. DOI: 10.1159/000329466.
31.	Lim JY, Lee SY, Kim JG, et al. Intravitreal bevacizumab alone versus in combination with photodynamic therapy for the treatment of neovascular maculopathy in patients aged 50 years or older: 1-year results of a prospective clinical study[J].Acta Ophthalmol, 2012, 90(1):61-67.DOI:10.1111/j.1755-3768.2009.01841.x.
32.	刘会娟, 宋艳萍, 陈中山, 等.玻璃体腔注射雷珠单抗与玻璃体腔注射雷珠单抗联合光动力疗法治疗息肉样脉络膜血管病变的视力预后比较[J].中华眼底病杂志, 2014, 30(3): 249-252. DOI:10.3760/cma.j.issn.1005-1015.2014.03.006.Liu HJ, Song YP, Chen ZS, et al.Comparison of visual outcomes between intravitreal ranibizumab injection combined with or without photodynamic therapy for polypoidal choroidal vasculopathy[J]. Chin J Ocul Fundus Dis, 2014, 30(3):249-252. DOI:10.3760/cma.j.issn.1005-1015.2014.03.006.
33.	Lai TY, Chan WM, Liu DT, et al. Intravitreal bevacizumab (Avastin) with or without photodynamic therapy for the treatment of polypoidal choroidal vasculopathy[J]. Br J Ophthalmol, 2008, 92(5):661-666. DOI: 10.1136/bjo.2007.135103.
34.	Lee SY, Kim JG, Joe SG, et al. The therapeutic effects of bevacizumab in patients with polypoidal choroidal vasculopathy[J]. Korean J Ophthalmol, 2008, 22(2):92-99. DOI:10.3341/kjo.2008.22.2.92.
35.	孙祖华, 林冰, 李英姿, 等.息肉样脉络膜血管病变临床个性化治疗效果评价[J].中华眼底病杂志, 2014, 30(3):235-240. DOI:10.3760/cma.j.issn.1005-1015.2014.03.003.Sun ZH, Lin B, Li YZ, et al.Effects of personalized clinical therapy for polypoidal choroidal vasculopathy[J].Chin J Ocul Fundus Dis, 2014, 30(3):235-240. DOI:10.3760/cma.j.issn.1005-1015.2014.03.003.
36.	Tsujikawa A, Hirami Y, Nakanishi H, et al. Retinal pigment epithelial tear in polypoidal choroidal vasculopathy[J]. Retina, 2007, 27(7):832-838.
37.	Hirami Y, Tsujikawa A, Otani A, et al. Hemorrhagic complications after photodynamic therapy for polypoidal choroidal vasculopathy[J]. Retina, 2007, 27(3):335-341.DOI:10.1097/01.iae.0000233647.78726.46.
38.	Tatar O, Adam A, Shinoda K, et al. Expression of VEGF and PEDF in choroidal neovascular membranes following verteporfin photodynamic therapy[J]. Am J Ophthalmol, 2006, 142(1):95-104.
39.	Tatar O, Shinoda K, Adam A, et al. Effect of verteporfin photodynamic therapy on endostatin and angiogenesis in human choroidal neovascular membranes[J]. Br J Ophthalmol, 2007, 91(2):166-173.
40.	Gomi F, Oshima Y, Mori R, et al. Initial versus delayed photodynamic therapy in combination with ranibizumab for treatment of polypoidal choroidal vasculopathy: the Fujisan Study[J]. Retina, 2015. DOI: 10.1097/IAE.0000000000000526.

1. Koh AH, Chen LJ, Chen SJ, et al. Polypoidal choroidal vasculopathy: evidence-based guidelines for clinical diagnosis and treatment[J]. Retina, 2013, 33(4):686-716. DOI:10.1097/IAE.0b013e3182852446.
2. Leal S, Silva R, Figueira J, et al. Photodynamic therapy with verteporfin in polypoidal choroidal vasculopathy: results after 3 years of follow-up[J]. Retina, 2010, 30(8):1197-1205. DOI: 10.1097/IAE.0b013e3181d37486.
3. Akaza E, Yuzawa M, Mori R. Three-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy[J]. Jpn J Ophthalmol, 2011, 55(1):39-44. DOI: 10.1007/s10384-010-0886-x.
4. Michels S, Schmidt-Erfurth U. Sequence of early vascular events after photodynamic therapy[J]. Invest Ophthalmol Vis Sci, 2003, 44(5):2147-2154.
5. Schlotzer-Schrehardt U, Viestenz A, Naumann GO, et al. Dose-related structural effects of photodynamic therapy on choroidal and retinal structures of human eyes[J]. Graefe's Arch Clin Exp Ophthalmol, 2002, 240(9):748-757.
6. Schmidt-Erfurth U, Schlotzer-Schrehard U, Cursiefen C, et al. Influence of photodynamic therapy on expression of vascular endothelial growth factor (VEGF), VEGF receptor 3, and pigment epithelium-derived factor[J]. Invest Ophthalmol Vis Sci, 2003, 44(10):4473-4480.
7. Alshahrani ST, Al SH, Kahtani ES, et al. Spectral-domain optical coherence tomography findings in polypoidal choroidal vasculopathy suggest a typeⅠneovascular growth pattern[J]. Clin Ophthalmol, 2014, 8:1689-1695. DOI: 10.2147/OPTH.S68471.
8. Kokame GT. Polypoidal choroidal vasculopathy-a typeⅠpolypoidal subretinal neovasculopathy[J]. Open Ophthalmol J, 2013, 7:82-84.DOI: 10.2174/1874364101307010082.
9. Matsuoka M, Ogata N, Otsuji T, et al. Expression of pigment epithelium derived factor and vascular endothelial growth factor in choroidal neovascular membranes and polypoidal choroidal vasculopathy[J]. Br J Ophthalmol, 2004, 88(6):809-815. DOI: 10.2174/1874364101307010082.
10. Tong J P, Chan WM, Liu DT, et al. Aqueous humor levels of vascular endothelial growth factor and pigment epithelium-derived factor in polypoidal choroidal vasculopathy and choroidal neovascularization[J]. Am J Ophthalmol, 2006, 141(3): 456-462.
11. Wong CW, Wong TY, Cheung CM. Polypoidal choroidal vasculopathy in Asians[J]. J Clin Med, 2015, 4(5):782-821. DOI: 10.3390/jcm4050782.
12. O'Connor D, Green S, Higgins JPT, et al. Part 2:General methods for Cochrane reviews[M]//Julian Pt Higgins SG. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration, 2011. http://handbook.cochrane.org.
13. Reeves BC, Deeks JJ, Higgins JPT, et al. Part 3:Special topics[M]//Julian Pt Higgins SG. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration, 2011. http://handbook.cochrane.org.
14. Koh A, Lee WK, Chen LJ, et al. 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[J]. Retina, 2012, 32(8):1453-1464.DOI:10.1097/IAE.0b013e31824f91e8.
15. Oishi A, Kojima H, Mandai M, et al. Comparison of the effect of ranibizumab and verteporfin for polypoidal choroidal vasculopathy: 12-month LAPTOP study results[J]. Am J Ophthalmol, 2013, 156(4):644-651. DOI: 10.1016/j.ajo.2013.05.024.
16. Oishi A, Miyamoto N, Mandai M, et al. LAPTOP study: a 24-month trial of verteporfin versus ranibizumab for polypoidal choroidal vasculopathy[J]. Ophthalmology, 2014, 121(5):1151-1152. DOI: 10.1016/j.ophtha.2013.12.037.
17. Lai TY, Lee GK, Luk FO, et al. Intravitreal ranibizumab with or without photodynamic therapy for the treatment of symptomatic polypoidal choroidal vasculopathy[J]. Retina, 2011, 31(8):1581-1588. DOI: 10.1097/IAE.0b013e31820d3f3f.
18. Kang HM, Koh HJ. Two-year outcome after combination therapy for polypoidal choroidal vasculopathy: comparison with photodynamic monotherapy and anti-vascular endothelial growth factor monotherapy[J]. Ophthalmologica, 2014, 231(2):86-93. DOI: 10.1159/000354546.
19. Mitamura Y, Kitahashi M, Kubota-Taniai M, et al. Comparison of intravitreal bevacizumab to photodynamic therapy for polypoidal choroidal vasculopathy: short-term results[J]. Indian J Ophthalmol, 2010, 58(4):291-296. DOI: 10.4103/0301-4738.64130.
20. Saito M, Iida T, Kano M. Intravitreal ranibizumab for polypoidal choroidal vasculopathy with recurrent or residual exudation[J]. Retina, 2011, 31(8): 1589-1597.DOI: 10.1097/IAE.0b013e31820f4b21.
21. Rouvas AA, Papakostas TD, Ntouraki A, et al. Photodynamic therapy, ranibizumab, and ranibizumab with photodynamic therapy for the treatment of polypoidal choroidal vasculopathy[J]. Retina, 2011, 31(3):464-474. DOI: 10.1097/IAE.0b013e3181f274ec.
22. Inoue M, Arakawa A, Yamane S, et al. Long-term outcome of intravitreal ranibizumab treatment, compared with photodynamic therapy, in patients with polypoidal choroidal vasculopathy[J]. Eye (Lond), 2013, 27(9):1013-1020, 1021. DOI: 10.1038/eye.2013.179.
23. Kim SJ, Yu HG. Efficacy of combined photodynamic therapy and intravitreal bevacizumab injection versus photodynamic therapy alone in polypoidal choroidal vasculopathy[J]. Retina, 2011, 31(9):1827-1834. DOI: 10.1097/IAE.0b013e318214d01e.
24. Gomi F, Sawa M, Wakabayashi T, et al. Efficacy of intravitreal bevacizumab combined with photodynamic therapy for polypoidal choroidal vasculopathy[J]. Am J Ophthalmol, 2010, 150(1):48-54. DOI: 10.1016/j.ajo.2010.02.008.
25. Lee YA, Yang CH, Yang CM, et al. Photodynamic therapy with or without intravitreal bevacizumab for polypoidal choroidal vasculopathy: two years of follow-up[J]. Am J Ophthalmol, 2012, 154(5):872-880. DOI: 10.1016/j.ajo.2012.03.051.
26. Maruko I, Iida T, Sugano Y, et al. Subfoveal retinal and choroidal thickness after verteporfin photodynamic therapy for polypoidal choroidal vasculopathy[J]. Am J Ophthalmol, 2011, 151(4):594-603. DOI: 10.1016/j.ajo.2010.10.030.
27. Saito M, Iida T, Kano M, et al. Two-year results of combined intravitreal ranibizumab and photodynamic therapy for polypoidal choroidal vasculopathy[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(9):2099-2110. DOI: 10.1007/s00417-013-2323-6.
28. Sakurada Y, Iijima H. Two-year results of photodynamic therapy with or without intravitreal ranibizumab for polypoidal choroidal vasculopathy[J]. J Ocul Pharmacol Ther, 2013, 29(9):832-836. DOI: 10.1089/jop.2013.0044.
29. Nakata I, Tsujikawa A, Yamashiro K, et al. Two-year outcome of photodynamic therapy combined with intravitreal injection of bevacizumab and triamcinolone acetonide for polypoidal choroidal vasculopathy[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(4):1073-1080. DOI:10.1007/s00417-012-2137-y.
30. Song MH, Ryu HW, Roh YJ. One-year results of intravitreal ranibizumab with or without photodynamic therapy for polypoidal choroidal vasculopathy[J]. Ophthalmologica, 2011, 226(3):119-126. DOI: 10.1159/000329466.
31. Lim JY, Lee SY, Kim JG, et al. Intravitreal bevacizumab alone versus in combination with photodynamic therapy for the treatment of neovascular maculopathy in patients aged 50 years or older: 1-year results of a prospective clinical study[J].Acta Ophthalmol, 2012, 90(1):61-67.DOI:10.1111/j.1755-3768.2009.01841.x.
32. 刘会娟, 宋艳萍, 陈中山, 等.玻璃体腔注射雷珠单抗与玻璃体腔注射雷珠单抗联合光动力疗法治疗息肉样脉络膜血管病变的视力预后比较[J].中华眼底病杂志, 2014, 30(3): 249-252. DOI:10.3760/cma.j.issn.1005-1015.2014.03.006.Liu HJ, Song YP, Chen ZS, et al.Comparison of visual outcomes between intravitreal ranibizumab injection combined with or without photodynamic therapy for polypoidal choroidal vasculopathy[J]. Chin J Ocul Fundus Dis, 2014, 30(3):249-252. DOI:10.3760/cma.j.issn.1005-1015.2014.03.006.
33. Lai TY, Chan WM, Liu DT, et al. Intravitreal bevacizumab (Avastin) with or without photodynamic therapy for the treatment of polypoidal choroidal vasculopathy[J]. Br J Ophthalmol, 2008, 92(5):661-666. DOI: 10.1136/bjo.2007.135103.
34. Lee SY, Kim JG, Joe SG, et al. The therapeutic effects of bevacizumab in patients with polypoidal choroidal vasculopathy[J]. Korean J Ophthalmol, 2008, 22(2):92-99. DOI:10.3341/kjo.2008.22.2.92.
35. 孙祖华, 林冰, 李英姿, 等.息肉样脉络膜血管病变临床个性化治疗效果评价[J].中华眼底病杂志, 2014, 30(3):235-240. DOI:10.3760/cma.j.issn.1005-1015.2014.03.003.Sun ZH, Lin B, Li YZ, et al.Effects of personalized clinical therapy for polypoidal choroidal vasculopathy[J].Chin J Ocul Fundus Dis, 2014, 30(3):235-240. DOI:10.3760/cma.j.issn.1005-1015.2014.03.003.
36. Tsujikawa A, Hirami Y, Nakanishi H, et al. Retinal pigment epithelial tear in polypoidal choroidal vasculopathy[J]. Retina, 2007, 27(7):832-838.
37. Hirami Y, Tsujikawa A, Otani A, et al. Hemorrhagic complications after photodynamic therapy for polypoidal choroidal vasculopathy[J]. Retina, 2007, 27(3):335-341.DOI:10.1097/01.iae.0000233647.78726.46.
38. Tatar O, Adam A, Shinoda K, et al. Expression of VEGF and PEDF in choroidal neovascular membranes following verteporfin photodynamic therapy[J]. Am J Ophthalmol, 2006, 142(1):95-104.
39. Tatar O, Shinoda K, Adam A, et al. Effect of verteporfin photodynamic therapy on endostatin and angiogenesis in human choroidal neovascular membranes[J]. Br J Ophthalmol, 2007, 91(2):166-173.
40. Gomi F, Oshima Y, Mori R, et al. Initial versus delayed photodynamic therapy in combination with ranibizumab for treatment of polypoidal choroidal vasculopathy: the Fujisan Study[J]. Retina, 2015. DOI: 10.1097/IAE.0000000000000526.

Chinese Journal of Ocular Fundus Diseases

Meta-analysis of photodynamic therapy and intravitreal injection of anti-vascular endothelial growth factor agent in the treatment of polypoid choroidal vasculopathy

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