Treatment of myopic choroidal neovascularization: a network meta-analysis and review

Abstract

Purpose This is, to our knowledge, the first network meta-analysis aiming to compare all treatment modalities for myopic choroidal neovascularization (CNV). Methods After the electronic databases were searched, two independent reviewers screened titles, abstracts, full-texts, and extracted information. Primary endpoints were change in visual outcome and central retinal thickness. We used a network meta-analysis to compare treatment outcomes in the early (≤ 6 months) and late (> 6 months) phase. Results We included 34 studies (2,098 eyes) in our network meta-analysis. In the early phase, the use of anti-VEGF led to a gain of 14.1 letters (95% CI, 10.8–17.4) compared to untreated patients (p < 0.0001), 12.1 letters (95% CI, 8.3–15.8) to photodynamic therapy (PDT) (p < 0.0001), 7.5 (95% CI, 1.2–13.8) letters to intravitreal triamcinolone acetonide (TCA) (p = 0.019), and − 2.9 letters (95% CI, − 6.0–0.2) to the combination of anti-VEGF and PDT (p = 0.065). In the later phase, these results were largely maintained. There were no significant differences in visual outcomes between patients treated with 1 + PRN and 3 + PRN. However, the 1 + PRN group received 1.8 (SD 1.3), while the 3 + PRN group received 3.2 (SD 0.9) injections within 12 months (p < 0.0001). Conclusion This network meta-analysis confirms that anti-VEGF is the most effective treatment for myopic CNV using the 1 + PRN treatment strategy.