光动力疗法联合玻璃体腔注射抗血管内皮生长因子制剂与单纯光动力疗法治疗息肉样脉络膜血管病变的系统评价

Intravitreal injection of anti-vascular endothelial growth factor combined with photodynamic therapy or photodynamic therapy only for polypoidal choroidal vascolopathy., a systematic review

目的系统评价光动力疗法（PDT）联合玻璃体腔注射抗血管内皮生长因子制剂与单纯PDT治疗息肉样脉络膜血管病变的疗效及安全性。方法以“息肉样脉络膜血管病变、光动力治疗、抗血管内皮生长因子制剂／玻璃体腔注射、联合治疗”等中英文检索词，计算机检索Pubmed、0VID等外文数据库，中国生物医学文献数据库（cBM）、中国知网全文数据库（CNKI）等中文数据库。手工检索相关期刊和会议文献，包括相关综述及所获文献的参考文献。纳入相关随机和非随机对照试验。文献发表时间截止2011年9月，语种不限。以最佳矫正视力、息肉样病灶消退和复发率、视网膜色素上皮脱离缓解或者消退率、严重视力下降甚至失明、视网膜下出血并发率为结局指标，采用荟萃分析软件（RevMan）5．0进行统计分析。结果共纳入比较联合治疗与单纯PDT治疗的随机对照临床试验1个，非随机对照试验4个，涉及受试对象273例。其中，单纯治疗组148例，联合治疗组125例。荟萃分析结果显示，治疗后6、12个月，两组最小分辨角对数最佳矫正视力标准化均数差分别为0．01、0．04，相应95％可信区间（C，）分别为（-0．12，0．14）、（-0．16，0．25），差异均无统计学意义（P=0．84、0．69）；治疗后3个月，两组息肉样病灶消退率比较，差异无统计学意义[优势比（OR）=1．38，95％CI（O．74，2．55），P=0．31]；治疗后12个月，两组视网膜色素上皮脱离缓解或者消退率比较，差异无统计学意义EOR=0．67，95％CI（O．12，3．69），P=0．653；治疗后12个月，两组息肉样病灶复发率比较，差异无统计学意义[OR=1．14，95％CI（0．58，2．24），P=0．71]；治疗后12个月，两者视力下降大于3行或者失明发生率比较，差异无统计学意义[OR=1．20，95％CI（0．34，4．11），P=O．78]；治疗后12个月，单纯组并发视网膜下出血发生率较联合组高，差异有统计学意义[OR=0．44，95％CI（0．18，0．94），P=0．043。结论与单纯PDT相比，联合疗法的视网膜下出血发生率较低，其视力改善、病灶消退、病灶复发率方面效果是否优于单纯PDT尚不确定。

Objective To evaluate the efficacy and safety of intravitreal anti-vascular endothelial growth factor （VEGF） combined with photodynamic therapy （PDT） vs. photodynamic therapy for polypoidal choroidal vasculopathy （PCV）. Methods A computerized search was conducted in Pubmed, OVID, Chinese Biological Medicine Database（CBM）, China National Knowledge Infrastructure （CNKI） by using key words ＂polypoidal choroidal vasculopathy, photodynamic therapy, intravitreal anti-VEGF＂ in Chinese and/or English combined with manually searching of bibliographies of pertinent articles, journals and literature reference proceedings. Randomized controlled trials （RCT） and non-RCT were collected. The search time was ranged from establishment of each database to September, 2011. The search was no limitation in language. The best corrected visual acuity （BCVA）, resolution and recurring of lesions, decrease or complete resolution of pigment epithelial detachment （PED）, visual extinction or blindness rate,the rate of subretinal hemorrhage were analyzed by RevMan 5.0 software. Results In total, one RCT and four non-RCTs （273 patients） were included in the recta-analysis involving 148 patients in single treatment group and 125 patients in combined treatment group. The results of meta-analyses showed that there was no significant difference between two groups in the mean logarithm of minimal angle of resolution BCVA at six months standard mean difference= 0.01, 95 % confidence interval （CI） ： --0.12 - 0.14, P= 0.84] and 12 months ~standard mean difference = 0.04, 95% CI： -0.16 - 0.25, P=0. 691 after treatment. There was no significant difference between two groups in the resolution of lesions odds ratio （OR）= 1.38, 95 % CI： 0.74 - 2.55, P=0.31] at the months after treatment and decrease or complete resolution of PED （OR= 0.67, 95 % CI： 0.12 - 3.69, P=0.65） at 12 months after treatment. There was no significant difference between two groups in the recurring of lesions （OR=I. 14, 95% CI： O. 58 - 2.24, P=0.71） and lost of three lines vision or blindness rate （OR= 1.20, 95% CI： O. 34 - 4.18, P = 0.78） at 12 months after treatment. The rate of subretinal hemorrhage in combine treatment group was significant lower than single treatment group （OR=0. 41, 95% CI： O. 18 - 0.94, P= 0.04）. Conclusions The incidence of subretinal hemorrhage occurred in patients with PCV after intravitreal anti-VEGF combined with PDT is much lower than that after single PDT. But the visual improvement, resolution of lesions and recurring of lesions of combined treatment need further studied to see if it is better than single PDT.