title: Intravitreal anti-vascular endothelial growth factor for choroidal neovascularization secondary to pathologic myopia: systematic review and meta-analysis.
abstract: OBJECTIVE
  To update existing evidence and evaluate intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections for myopic choroidal neovascularization.
  
  
  METHODS
  The authors conducted comprehensive search in PubMed, EMBASE, Cochrane Library, Biosis Preview, and LILACS. Included studies were categorized by study design. Comparative studies were classified as randomized controlled trials (RCTs) and non-RCT studies, and these two types of studies were presented and meta-analyzed separately for the following comparisons: 1) anti-VEGF versus photodynamic therapy, 2) anti-VEGF monotherapy versus combination therapy with photodynamic therapy, 3) single versus 3 monthly injections followed by pro re nata (PRN) treatment, and 4) ranibizumab versus bevacizumab. Noncomparative prospective series were pooled to estimate mean visual gain, mean retinal thickness change, and the average number of anti-VEGF injections required for myopic choroidal neovascularization. Ocular and systemic adverse events were also summarized.
  
  
  RESULTS
  Literature search yielded 18 comparative studies and 83 noncomparative studies. Superiority of anti-VEGF over photodynamic therapy in a 24-month period was confirmed by 2 RCTs and 6 non-RCT studies. The influence of combined photodynamic therapy was uncertain based on two non-RCT studies. Three non-RCT studies showed that the visual outcomes of 3+PRN injections might be slightly better than 1+PRN injections within 1 year. No difference was observed between ranibizumab and bevacizumab in two RCTs and one non-RCT study. The estimated visual improvement was two lines on average. Adverse events were uncommon as reported.
  
  
  CONCLUSIONS
  Accumulating evidence confirmed that anti-VEGF injections should be the first-line therapy for myopic choroidal neovascularization.
authors.affiliation: Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Erqian
authors.initials: E
authors.lastname: Wang
authors.forename: Youxin
authors.initials: Y
authors.lastname: Chen
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000209:etiology; D002986:Clinical Trials as Topic; D006801:Humans; D058449:Intravitreal Injections; D009216:Myopia / Q000150:complications*; D000069579:Ranibizumab; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab