title: Ranibizumab alone or in combination with photodynamic therapy vs photodynamic therapy for polypoidal choroidal vasculopathy: a systematic review and Meta-analysis.
abstract: OBJECTIVE
  To compare the efficacy of intravitreal ranibizumab (IVR) alone or in combination with photodynamic therapy (PDT) vs PDT in patients with symptomatic polypoidal choroidal vasculopathy (PCV).
  
  
  METHODS
  A systematic search of a wide range of databases (including PubMed, EMBASE, Cochrane Library and Web of Science) was searched to identify relevant studies. Both randomized controlled trials (RCTs) and non-RCT studies were included. Methodological quality of included literatures was evaluated according to the Newcastle-Ottawa Scale. RevMan 5.2.7 software was used to do the Meta-analysis.
  
  
  RESULTS
  Three RCTs and 6 retrospective studies were included. The results showed that PDT monotherapy had a significantly higher proportion in patients who achieved complete regression of polyps than IVR monotherapy at months 3, 6, and 12 (All P≤0.01), respectively. However, IVR had a tendency to be more effective in improving vision on the basis of RCTs. The proportion of patients who gained complete regression of polyps revealed that there was no significant difference between the combination treatment and PDT monotherapy. The mean change of best-corrected visual acuity (BCVA) from baseline showed that the combination treatment had significant superiority in improving vision vs PDT monotherapy at months 3, 6 and 24 (All P<0.05), respectively. In the mean time, this comparison result was also significant at month 12 (P<0.01) after removal of a heterogeneous study.
  
  
  CONCLUSIONS
  IVR has non-inferiority compare with PDT either in stabilizing or in improving vision, although it can hardly promote the regression of polyps. The combination treatment of PDT and IVR can exert a synergistic effect on regressing polyps and on maintaining or improving visual acuity. Thus, it can be the first-line therapy for PCV.
authors.affiliation: Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China ; Department of Ophthalmology, Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Tang
authors.affiliation: Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China ; Department of Ophthalmology, Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China.
authors.forename: Jun-Kang
authors.initials: JK
authors.lastname: Si
authors.affiliation: Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China.
authors.forename: Da-Dong
authors.initials: DD
authors.lastname: Guo
authors.affiliation: Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Cui
authors.affiliation: Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China ; Department of Ophthalmology, Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China.
authors.forename: Yu-Xiang
authors.initials: YX
authors.lastname: Du
authors.affiliation: Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China.
authors.forename: Xue-Mei
authors.initials: XM
authors.lastname: Pan
authors.affiliation: Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China ; Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan 250002, Shandong Province, China.
authors.forename: Hong-Sheng
authors.initials: HS
authors.lastname: Bi
keywords: Meta-analysis; combination treatment; monotherapy; photodynamic therapy; polypoidal choroidal vasculopathy; ranibizumab; systematic review