Quantitative analysis of retinal intermediate and deep capillary plexus in patients with retinal deep vascular complex ischemia

AIM: To evaluate the efficacy and safety of intravitreal corticoid as an adjunctive therapy to anti-VEGF treatment of neovascular age-related macular Degeneration (nvAMD). METHODS: Four databases including PubMed, Embase, Cochrane Library, and the clinicaltrials.gov were comprehensively searched for studies comparing intravitreal corticoid plus anti-VEGF (IVC/IVA) vs anti-VEGF monotherapy (IVA) in patients with nvAMD. GRADE profiler was used to assess the quality of outcomes. Best-corrected visual acuity (BCVA), central macular thickness (CMT) and adverse events including the occurrence of severe elevation of intraretinal pressure (IOP) and the progress of cataract were extracted from the eligible studies. Review Manager (RevMan) 5.3 was used to analyze the data. RESULTS: There was no statistic difference between mean change in BCVA at 6mo and 12mo (95% CI: -2.28 to 4.24, P=0.55). Mean change of CMT at 6mo and 12mo: no statistically significant difference were found in CMT at this time point (95% CI:-17.98 to 16.42, P=0.93). Occurrence of severe elevation of IOP: the risk in the IVC/IVA group was higher than that in the IVA group (95% CI: 1.92 to 9.48; P=0.0004). Cataract progression events: no statistic difference was found (95% CI: 0.74 to 4.66; P=0.18). CONCLUSION: No visual or anatomical benefits are observed in IVC/IVA group at 6mo. At 12mo, the CMT of the IVC/IVA group is significantly lower than that of the IVA group. Risk of severe elevation of IOP is significantly higher when treated by IVC/IVA.