title: Comparison of the efficacy of anti-VEGF monotherapy versus PDT and intravitreal anti-VEGF combination treatment in AMD: a Meta-analysis and systematic review.
abstract: OBJECTIVE
  To compare the effect of anti-vascular endothelial growth factor (VEGF) monotherapy versus photodynamic therapy (PDT) and anti-VEGF combination treatment in age-related macular degeneration (AMD).
  
  
  METHODS
  A computerized online search was performed using PubMed, Web of Science and the Cochrane Library. Studies that compared anti-VEGF monotherapy with PDT and anti-VEGF combination treatment of AMD and were designed as randomized controlled trials were included. The means and standard deviations of the best-corrected visual acuity (BCVA), central retinal thickness (CRT), number of treatments and proportions of patients who gained BCVA ≥15, 10, 5, or 0 letters at 12(th) month were extracted. A systematic review and Meta-analysis of the comparison of the two approaches was conducted using Review Manager 5.2. Subgroup. A sensitivity analysis was also performed.
  
  
  RESULTS
  Eight studies were included. When the subgroup and sensitivity analysis was conducted, the results indicated that in the findings that included the monotherapy group and PDT (standard fluence, SF) group of Kaiser's study, the patients in the monotherapy group had a better BCVA compared with the combination group at 12(th) month in the PDT (SF) subgroup [weighted mean difference (WMD): 3.54; 95%CI: 0.36 to 6.73; P=0.03], and there were more patients who gained ≥15 letters of BCVA in the monotherapy group compared with the combination group in the total result [odds ratio (OR): 1.41; 95%CI: 1.02 to 1.95; P=0.04]. The same conclusion was obtained in the total result that included the monotherapy group and PDT (reduced fluence, RF) group of Kaiser's study (OR: 1.56; 95%CI: 1.13 to 2.15; P=0.007). However, there were no significant differences in the other indexes between the two therapies.
  
  
  CONCLUSIONS
  We found that anti-VEGF monotherapy is more effective on the recovery of visual acuity than combination therapy and more researches with lager sample size should be performed to study on the effect of the two therapy approaches on CRT and number of injections.
authors: Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China; Department of Ophthalmology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors: Yao
authors: Y
authors: Tong
authors: Department of Ophthalmology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
authors: Ke-Ke
authors: KK
authors: Zhao
authors: Department of Ophthalmology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou 310006, Zhejiang Province, China.
authors: Dong
authors: D
authors: Feng
authors: Department of Molecular Genetics, University of Florida, Gainesville 32610, Florida, USA.
authors: Manas
authors: M
authors: Biswal
authors: Department of Ophthalmology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors: Pei-Quan
authors: PQ
authors: Zhao
authors: Department of Ophthalmology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
authors: Zhao-Yang
authors: ZY
authors: Wang
authors: Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.
authors: Yun
authors: Y
authors: Zhang
keywords: Meta-analysis; age-related macular degeneration; anti-vascular endothelial growth factor; photodynamic therapy