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

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.