Outcomes in PIC-Related CNV: Pooled Analysis of Individual Participant Data

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Authors: Kirill Zaslavsky ; Teresa Park ; Rachel Lang Mcinnis ; Mark Mandell ; Jihwan Lee ; Christopher Lee ; Rose Gilbert ; Larissa Derzko-Dzulynsky

Citation: OCULAR IMMUNOLOGY AND INFLAMMATION, Vol.31(9) : 1825-1836, 2023-11

MeSH: Angiogenesis Inhibitors / therapeutic use ; Choroidal Neovascularization* / diagnosis ; Choroidal Neovascularization* / drug therapy ; Eye ; Fluorescein Angiography ; Humans ; Retrospective Studies ; White Dot Syndromes* / drug therapy

Keywords: Anti-VEGF ; choroidal neovascularization ; immunosuppression ; photodynamic therapy ; posterior uveitis ; punctate inner choroidopathy ; white dot syndrome

Abstract: Choroidal neovascularization (CNV) affects 64-75% of eyes with punctate inner choroidopathy (PIC). Although anti-VEGF agents are considered first-line therapy, there is controversy regarding other modalities, such as immunosuppression. We performed a systematic review of individual participant data (IPD) and generated a dataset of 278 eyes with PIC-related CNV from 45 studies. Forty-two percent presented with moderate visual loss (MVL) or worse. Four different treatment modalities (anti-VEGF, photodynamic therapy, local immunosuppression, and systemic immunosuppression) and most combinations among them were represented. Anti-VEGF injections decreased the likelihood of MVL (Odds Ratio 0.3, p = .027), an effect moderated by presenting visual acuity and patient age. Eyes receiving more than 3 injections were more likely to receive additional therapeutic modalities. Increasing number of modalities was associated with longer follow-up time and did not improve vision. The beneficial effect of anti-VEGF injections persisted when controlling for presenting visual acuity and follow-up time.