Different approaches for the treatment of myopic choroidal neovascular: a network meta-analysis

Different approaches for the treatment of myopic choroidal neovascular: a network meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Different approaches for the treatment of myopic choroidal neovascular: a network meta-analysis Yajun Wu, Yuliang Feng, Jiasong Yang, Hua Fan, Zitong Yu, Xiaolin Xie, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1988277/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: In order to evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs, photodynamic therapy (PDT), and laser treatment (LT) for anatomical and functional improvement in myopic choroidal neovascularization (mCNV) patients were evaluated in a mesh meta-analysis. Methods: Two researchers independently searched PubMed, Cochrane Library, Web of Science, CNKI, WanFang Data, Embase, and other databases to screen RCTs and retrospective studies comparing best-corrected visual acuity (BCVA) and foveal center thickness (FCT) changes after mCNV treatment. The retrieval time limit is from the database construction to November 30, 2021. ADDIS1.16.8 and R 3.5.3 software were used to conduct mesh meta-analyses of RCTs and retrospective studies, respectively. Results: A total of 601 eyes in 8 RCTs involving 6 treatment options: intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR), intravitreal conbercept (IVC), intravitreal aflibercept (IVA), LT, PDT, sham first followed by IVA (Sham /IVA). The results of the mesh meta-analysis showed that: in the RCTs, IVB and IVR were superior to PDT [MD=0.18, 95%CI (0.01, 0.42)] in improving BCVA of mCNV patients, and all the therapeutic effects from high to low might be intravitreal IVA, IVB, IVR, LT, Sham/IVA, and PDT; the order of FCT thickness reduction from high to low is IVA, IVR, IVB, PDT. In addition, the results of BCVA after long-term treatment in retrospective studies showed that all the therapeutic effects from high to low might be IVA, IVC, IVB /IVR, IVB, IVR, PDT, PDT with IVB /IVR; as for the order of FCT thickness reduction from high to low is IVA, IVC, IVR, IVB, PDT. Conclusions: Anti-VEGF treatment in patients with long-term improvement in mCNV vision effect is best, using IVB or IVR alone to treat mCNV may be better than IVB or IVR combined with PDT; There was no significant difference in the improvement of visual acuity and macular edema in mCNV patients with different anti-VEGF drugs. Due to the limited number and quality of included literature, the above conclusions need to be confirmed by more large-sample and high-quality articles. aflibercept bevacizumab conbercept laser treatment myopic choroidal neovascularization network meta-analysis ranibizumab photodynamic therapy Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction At present, myopia has become a global public health problem, 1 as the main cause of the uncorrected refractive error, which has brought a huge economic burden every year. 2 A meta-analysis shows that the global potential productivity loss caused by uncorrected myopia was estimated to be $ 244 billion in 2015. 3 High myopia (HM) is defined as ametropia with a diopter (D) ≤-6 or less. 4 Moreover, HM was associated with a significant increase in visual impairment (VI), irreversible blindness, 5 and, more frightening still, a significant prevalence. According to a meta-analysis, nearly half of the world's population may suffer from myopia by 2050, of which the HM population will be as high as 10%. 6 Usually, while HM individuals have characteristic fundus pathological changes such as leopard-shaped fundus and chorioretinal atrophy, we call it pathological myopia (PM), 7 though there is no broad and clear clinical definition of the latter. Furthermore, compared with ordinary myopia, HM significantly increases the risk of complications caused by PM, such as retinal atrophy, retinal detachment (RD), cataract, glaucoma, myopic macular degeneration, and myopic choroidal neovascular (mCNV). 8 – 10 mCNV is one of the terrible complications from PM, affecting about 5–11% of PM patients, of which about 15% involve both eyes. 9 The disease mainly refers to the formation of abnormal neovascularization under the retinal pigment epithelium or retina. 11 Besides, the vision of patients who have not been treated for a long time will be significantly reduced or even blind. 12 Therefore, timely treatment of mCNV is very important. Currently, there are several treatments for mCNV, including retinal laser photocoagulation, photodynamic therapy (PDT), intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs, etc. All of them have been shown to be effective in the treatment of mCNV. Matsuda et al. found that after laser treatment (LT), mCNV patients were followed up for 13–60 months, despite the phenomenon of laser photocoagulation scar enlargement in about 80% of patients, almost all patients had no vision loss and were well-controlled. 13 Also, PDT was shown to improve visual acuity in patients with mCNV during a one-year follow-up. 14 In addition, with the emergence of anti-VEGF drugs and successful application in many other retinal angiogenic diseases, anti-VEGF therapy has gradually become a common treatment for mCNV. Currently, commonly used anti-VEGF drugs include aflibercept, ranibizumab, bevacizumab, and conbercept (which was produced in China and was approved by the State Food and Drug Administration of China in May 2017 for the treatment of mCNV). Although there have been meta-analyses on mCNV. But they are mainly traditional meta-analyses comparing two treatment methods. For example, Hu et al. 15 compared the efficacy of intravitreal bevacizumab (IVB) and ranibizumab (IVR) in the treatment of mCNV in a meta-analysis and confirmed that both of them were effective treatment measures, though there was no statistical difference between the two treatments as far as possible. Additionally, Wang et al. 16 compared the ranibizumab/bevacizumab with PDT treatment and found that anti-VEGF on mCNV treatment has a better curative effect. However, so far, no mesh meta-analysis has comprehensively compared various treatment methods and the four different anti-VEGF drugs. Therefore, the purpose of this study is to compare and rank the efficacy of several existing mCNV treatment methods, in order to obtain the best method of mCNV treatment and provide useful information for guiding the clinical treatment of the disease. Results Flow chart and characteristic table 1.1Literature search results We preliminarily searched 763 articles, deleted 61 duplicate articles, 617 non-comparative original articles were deleted, excluded 56 articles by reading the title and abstract, excluded 13 articles after reading the full text, and finally included 16 articles that met the criteria. Details are presented in Figure 1. 1.2 Basic characteristics of the included study A total of 16 articles were included, including 8 RCTs and 8 retrospective studies, involving 1072 eyes. The following is the characteristic table of the original literature (Table 1) Evidence network diagram Figure 2A shows the network diagram of 6 different mCNV treatment methods in the BCVA results of RCTs, a total of 6 interventions including IVA, IVR, IVB, PDT, LT, and sham-combined IVA were involved in the mesh meta-analysis; Figure 2B shows the network relationship diagram of different treatment methods for mCNV in the BCVA results from retrospective studies, the mesh meta-analysis involves 7 interventions: IVA, IVR, IVB, IVC, IVB or IVR treatment, PDT treatment alone, and PDT combined with IVB or IVR treatment; Figure 2C shows a network diagram of 4 different treatments(IVB, IVR, IVA, PDT) in RCTs of FCT results. Figure 2D shows a network diagram of 5 different treatments (IVA, IVB, IVC, IVR, PDT) in the FCT results of retrospective studies; The line thickness in the figure is positively correlated with the number of studies directly comparing the two interventions. The convergence and stability evaluation results of the study were included The convergence diagnosis diagram and trajectory density diagram are drawn to evaluate the convergence and stability of the model. Before 50000 iterations of the model, the convergence diagnosis diagram and trajectory diagram have converged. The density diagram is a curve with a normal shape and smooth distribution, and the bandwidth value approaches 0, suggesting that the convergence degree of the model is satisfactory and the stability is good. Results of mesh meta-analysis 4.1 RCTs 4.1.2 Results of BCVA changes In the 8 articles included, the changes in BCVA in patients were described. In the included study, a significant increase in BCVA from baseline after most treatments were observed. A comprehensive analysis was carried out using Addis and R software The results of mesh meta-analysis showed that: BCVA improvement after IVB and IVR treatment was better than PDT [MD=0.18, 95%CI (0.02, 0,40)], [MD=0.18, 95%CI (0.01, 0.42)]. There was no statistical significance in the comparison of postoperative hospital stay between other closure methods (The 95%CI contains 0, which means it is not statistically significant), as shown in Table 2. Node analysis showed that all P > 0.05, reflecting that there was no statistical inconsistency between the results of direct comparison and indirect comparison. See Table3 for the detailed results. ADDIS and R showed that the order of probability of improving visual acuity by mCNV treatment was IVA>IVB>IVR>LT> Sham /IVA>PDT, See Figure 3 and Table 4 for details. 4.1.2 Results of FCT changes Among all RCTs, there are 5 articles involving the change of FCT results, including IVB, IVA, IVR, and PDT. We extracted the data on FCT changes before and after mCNV treatment and found that these treatment methods have no statistical difference in reducing FCT. The detailed results are shown in Table 5(The 95%CI contains 0, which means it is not statistically significant); The results of the comparison and ranking of the effects of these four treatment methods show that IVA may have the best effect, followed by IVR and IVB, and PDT may have the worst effect. The detailed results are shown in Figure 4 and Table 6. 4.2 Retrospective studies 4.2.1 Results of BCVA changes The 8 included articles described BCVA changes after 12 months of treatment. Addis combined with R software was used for comprehensive analysis, Mesh meta results showed no statistical difference among all treatments (95%CI includes 0), See Table 7 for details. The node analysis method shows that the direct comparison results are consistent with the indirect comparison results (P > 0.05). See table 8 for the details. ADDIS combined with R shows that after 12 months of treatment with 7 different methods, the order of increasing the probability of BCVA in mCNV patients is IVA > IVC > IVR or IVB > IVB > IVR > PDT with IVB or IVR > PDT. See Figure 5 and Table 9 for details. 4.2.2 Results of FCT changes A total of 4 retrospective studies involved the changes in FCT results, including IVC, IVB, IVA, IVR, and PDT. We found that these treatment methods had no statistical difference in reducing FCT. The detailed results are shown in table 10; The results of the comparison and ranking of the effects of these five treatment methods show that IVA may have the best effect, followed by IVC, IVR, IVB, and PDT may have the worst effect. See Figure 6 and Table 11 for the detailed results. Discussion In order to comprehensively compare the efficacy of different anti-VEGF drugs, PDT, LT, and even several combination therapy methods, we initially tried to include only RCTs. However, due to the lack of statistically significant results after the combination of all appropriate RCTs, considering the limited current RCTs, therefore, we also conducted the same mesh meta-analysis on retrospective articles in order to find the most suitable clinical treatment method for mCNV, and the results were similar to RCTs. This is the first article to compare the efficacy of different mCNV treatment methods in RCTs and retrospective studies, involving a total of 16 articles. The results of both RCTs and retrospective studies showed that anti-VEGF therapy might be the best choice after a long-term treatment follow-up of about 12 months. According to the sequencing results, since most of the results showed no statistical significance, we could only get the best possible treatment. The results of RCT and retrospective studies show that among anti-VEGF drugs, IVA may have the best effect in restoring the structure and function of mCNV patients. However, due to the lack of statistical significance, this result is only a possible reference, and more literature and higher-quality data are needed to further confirm this result. mCNV is one of the complications of myopia with severe loss of vision. 35 Patients without timely treatment will have very poor vision. 36 For a long time in the past, laser therapy has been used to treat CNV, but it is limited to extrafoveal mCNV and not applicable to subfoveal mCNV. This treatment is prone to laser scar expansion and disease recurrence. 37 , 38 In our study, there is only one article involving LT, 24 and due to the small sample size, it only shows that the degree of vision decline of patients is better than PDT treatment, which has no great advantage in improving visual acuity. Moreover, the first approved mCNV method that could be used in the treatment is PDT. In fact, as early as 2001, a clinical study of mCNV treated 81 eyes with PDT and 39 eyes with glucose for sham treatment for 12 months, finally, it was found that compared with the control group, the visual acuity of mCNV patients treated with PDT tended to be stable or even improved, and there were no obvious adverse reactions, which proved that PDT can be used as an effective treatment for mCNV. 14 However, when followed up to 24 months, the visual acuity of the PDT treatment group was no longer significantly improved compared with the placebo control group, which can be said to be mainly manifested as stable visual acuity, which may be caused by PDT treatment exacerbating the development of choroidal retinal atrophy in myopia patients. 39 What`s more, all the articles included in our study that involved PDT treatment were followed up for 12 months, but there were different evaluations on its efficacy. Some studies’ results showed that the BCVA of mCNV patients improved, while others decreased. We speculated that this was related to the small sample size. After all, studies 26 , 33 , 34 with a large sample size all showed that BCVA could be improved after 12 months of PDT treatment. Intravitreal injection of anti-VEGF drugs is considered the first-line treatment of mCNV, 40 also, at the same time, it is the most economic burden of the treatment method. Conbercept is a new anti-VEGF drug from China, like aflibercept, it is a soluble receptor protein. The difference is that conbercept mainly contains extracellular domain 2 of VEGF receptor 1 and extracellular domains 3 and 4 of VEGF receptor 2, which are fused with Fc part of human immunoglobulin G1, 41 while aflibercept only contains extracellular domain 2 of human VEGF receptor 1. 40 The efficacy and safety of IVC in the treatment of mCNV have been verified. In a retrospective study in China, 34 mCNV eyes were treated with conbercept and followed up for 12 months. The logMAR BCVA of the patients increased by 4.12 ± 2.69 on average without complications or adverse events. 42 As with other anti-VEGF drugs, it can be used as a long-term therapeutic agent for mCNV, although its application is limited at present, especially in other countries. Furthermore, aflibercept has been used earlier for the treatment of mCNV, which has also been demonstrated a significant therapeutic effect. Luca et al. performed IVA treatment on 15 eyes of mCNV patients and finally found that the patients not only improved BCVA but also significantly reduced central retinal thickness, as well as decreased levels of vascular endothelial growth factor (VEGF) and placental growth factor (PIGF). 43 Besides, bevacizumab is a humanized monoclonal antibody (IgG1) targeting VEGF-A to inhibit angiogenesis, in addition, it is mainly composed of a fab region that binds to the target and an Fc region that performs an effector function. 44 What's more, ranibizumab is also a humanized monoclonal antibody fragment, but it only contains Fab fragment, which can also inhibit VEGF-A and prevent the formation of new blood vessels. 45 As one of the most commonly used anti-VEGF drugs, ranibizumab, and bevacizumab are commonly used to compare efficacy with each other, but they are currently considered to have the same efficacy in improving visual acuity in mCNV patients without statistical difference. 15 Thus, the four kinds of VEGF drugs can effectively inhibit the formation of new blood vessels, for the treatment of mCNV hope, but actually what drug effects best is yet to be concluded. Even in this study we just draw in the RCT group that IVB, IVR is superior to the PDT treatment, 4 kinds of anti-VEGF drugs between concrete and also did not have statistically significant results, we think that is likely to be factors such as literature insufficiency, the sample size is too little. There are several deficiencies in our study. First of all, we want to compare the long-term efficacy of different treatments, so we tried to choose 12 months as a follow-up time. However, only the data in retrospective studies meet the conditions of time unification. In RCTs, there are still two studies with BCVA results followed up for 3 months and 19 months respectively. As for the results of FCT, the data in most articles do not meet the follow-up time of 12 months. Secondly, we only selected the reduction of LogMAR BCVA, and FCT as the outcome index, because most of the included articles only included these indexes, and the changes in visual acuity and FCT are the most important indexes to evaluate the efficacy of mCNV. We tried to include the number of anti-VEGF injections as the outcome index, but the data included in the study is difficult to meet the extraction of this index. Finally, there are too few studies included in this study and the sample size is not large, which is why most of the results in this study are not statistically significant. In the future, we hope that there will be more appropriate studies, and we will update the data in time to get more reliable results. Anti-VEGF is the most effective drug to improve the retinal structure and function of mCNV patients. However, PDT and laser also have certain therapeutic effects, and patients will not have a heavy economic burden. But, we have only obtained the possible ranking results of efficacy: Aflibercept may be the most effective anti-VEGF drug for the treatment of mCNV, the above results may only have reference significance. After all, there is no statistical difference in the therapeutic effect of four different anti-VEGF drugs. These conclusions need to be confirmed by higher quality and larger sample studies. Method Protocol and registration This study has been pre-registered in the International Prospective Register of Systematic Reviews under the registration number PROSPERO (https://www.crd.york.ac.uk/prospero/): CRD42021287142. This network meta-analysis was conducted and presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. 17 Search Strategy In order to obtain appropriate randomized controlled trials (RCTs) and retrospective articles as far as possible, we searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, and other databases, the retrieval time limit is from the establishment of each database to November 30, 2021. The language of this article is limited to English, and the retrieval strategy is “myopia” AND “choroid neovascularization” OR “mCNV” AND “pathological myopia” OR “PM” AND “photodynamic therapy” OR “PDT” OR “anti-VEGF” OR “bevacizumab” OR “IVB” OR “aflibercept” OR “IVA” OR “ranibizumab” OR “IVR” OR “conbercept” OR “IVC” OR “laser treatment” OR “laser photocoagulation” OR “mCNV” AND “randomized controlled trials” OR “RCT” OR “retrospective studies”. Inclusion and exclusion criteria We included and analyzed RCTs and retrospective studies respectively. These studies are comparative articles on different treatment methods for mCNV patients, mainly including the comparison of best-corrected visual acuity (BCVA) changes before and after treatment. Inclusion criteria:1. mCNV patients (CNV patients secondary to PM: refractive error ≤ - 6.0 diopter, or axial length greater than 26 mm) received treatment, regardless of race, region, occupation, and age;2. The data were complete, including baseline BCVA and post-treatment BCVA.3. Comparison of the efficacy of at least two treatment methods. Exclusion criteria: 1. Study subjects are not patients with CNV secondary to PM; 2. Single-arm study without a comparison of treatment measures. 3. Non-original articles such as summarization and experience summary; 4. Incomplete data or incomplete data cannot be obtained from the author. Outcome The primary outcome was the mean change in BCVA after treatment from baseline, and the visual acuity was logarithmic visual acuity (logMAR) converted from BCVA measurements. The secondary outcome measure was the change in foveal center thickness (FCT) on optical coherence tomography (OCT). Literature selection and data extraction In this study, two authors (Yuliang Feng and Jiasong Yang) independently read the title and abstract of the article according to the inclusion and exclusion criteria, exclude the articles that clearly do not meet the requirements, and then determine the final included literature by reading the content of the article in detail. If the two authors disagree in this process, they will consult or discuss and submit it to the third senior researcher for adjudication, Missing data were obtained by contacting the corresponding authors of the included literature. Statistical analysis ADDIS 1.16.8(http://www.drugis.org/ index) and R version 3.5.3 18 (R Foundation for Statistical Computing, Vienna, Austria) software were used to analyze the data. In this study, quantitative data and mean square deviation (MD) were used as the effect indicator, and the MD and standard deviation (SD) of each group of data were extracted for joint analysis. Point estimates and 95% confidence intervals (CI) of each effect indicator were given. χ2 test (α=0.1) was used to analyze the heterogeneity among the included studies, and I 2 was used to determine the heterogeneity. If the heterogeneity among the results was small, the fixed-effect model was used for meta-analysis. Otherwise, if the heterogeneity among the results was large, the random-effect model was used for meta-analysis after excluding the influence of obvious clinical heterogeneity, and P<0.05 between each group was considered statistically significant. ADDIS software was used to calculate the potential Scale reduction factor (PSRF) to diagnose the convergence degree of the model. Set the initial value of 4 Markov chains, the initial value of the model is 2.5, refine the iteration step size by 10, adjust the number of iterations by 20000 times, and simulate the number of iterations by 50000 times. Only when the PSRF value tends to 1 indicates that the convergence of the model is satisfactory. The R software calls "RJAGS", "GEMTC" program package to establish the Bayesian model, and calls "Network" program package to draw the evidence Network diagram of each intervention. The straight line indicates that there is direct comparison evidence between the two interventions, and the wireless connection lacks direct comparison evidence. The thicker the line, the more studies that directly compared the two interventions. The optimal probability ranking curve (SUCRA) value was calculated, the ranking map was drawn to predict the ranking of therapeutic effects of various measures, and the forest map for direct comparison was drawn. For the study of generating Node Split nodes, the Node Split model was first used to test the consistency of direct comparison and indirect comparison. P > 0.05 indicated good consistency and the consistency model was used for analysis. Instead, adopt the inconsistency model. Declarations Author Contributions: Yajun Wu: responsible for writing and modifying manuscripts; Yuliang Feng and Jiasong Yang: responsible for independent screening of literature; Hua Fan: responsible for data statistics and chart making; Zitong Yu, Xiaolin Xie and Yumeng Dai responsible for proofreading and revising the language of the manuscript; Wensheng Li: responsible for the design of the study and guiding the revision of manuscript Conflict of Interest Disclosures: The authors declare no conflict of interest. Data Sharing Statement The data in this study are used to support the results of this study and can be obtained at the request of the corresponding authors. Funding Aier Eye Hospital Group Scientific Research Fund (AR2001D1). References Morgan IG, Ohno-Matsui K, Saw SM. Myopia. Lancet. 2012;379,9827:1739–1748. Smith TS, Frick KD, Holden BA, et al. Potential lost productivity resulting from the global burden of uncorrected refractive error. Bull World Health Organ. 2009;87(6):431–7. Naidoo KS, Fricke TR, Frick KD, et al. Potential Lost Productivity Resulting from the Global Burden of Myopia: Systematic Review, Meta-analysis, and Modeling. Ophthalmology.2018; 126(3):338–346. Morgan IG, He MG, Rose KA. Epidemic of pathologic myopia: What Can Laboratory Studies and Epidemiology Tell Us? Retina. 2017; 37(5):989–997. Verkicharla PK, Ohno-Matsui K, Saw SM. Current and predicted demographics of high myopia and an update of its associated pathological changes. Ophthalmic Physiol Optics.2015; 35(5):465e475. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016; 123(5): 1036–1042. Neelam K, Cheung CM, Ohno-Matsui K, et al. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res.2012;31(5): 495–525. Jiang Y, Lou S, Li Y, et al. High myopia and macular vascular density: an optical coherence tomography angiography study. BMC Ophthalmology. 2021; 21(1): 407–407. Wong TY, Ferreira A, Hughes R, et al. Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: An evidence-based systematic review. American Journal of Ophthalmology. 2014; 157(1): p. 9–25.e12. Ikuno Y. OVERVIEW OF THE COMPLICATIONS OF HIGH MYOPIA. Retina. 2017; 37(12): 2347–2351. Yang MC, Chen YP, Tan EC, et al. Epidemiology, treatment pattern and health care utilization of myopic choroidal neovascularization: a population based study. Jan J Ophthalmol.2017; 61(2): 159–168. Kojima A, Ohno-Matsui K, Teramukai S, et al. Estimation of visual outcome without treatment in patients with subfoveal choroidal neovascularization in pathologic myopia. Graefes Arch Clin Exp Ophthalmol.2006; 244:1474–9. Matsuda S, Harino S, Iwahashi Y, et al. Long-term enlargement of laser photocoagulation scars after treatment of choroidal neovascularization. Nippon Ganka Gakkai zasshi. 2002; 106(11): 708–13. Verteporfin in Photodynamic Therapy Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in pathologic myopia with verteporfin. 1-year results of a randomized clinical trial–VIP report no. 1 Ophthalmology. 2001;108(5):841–852. Hu Q, Li H, Du Y, et al. Comparison of intravitreal bevacizumab and ranibizumab used for myopic choroidal neovascularization: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials. Medicine.2019; 98(12): e14905. Wang E, Chen Y. Intravitreal anti-vascular endothelial growth factor for choroidal neovascularization secondary to pathologic myopia: systematic review and meta-analysis. Retina. 2013; 33(7): 1375–92. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 Statement: an Updated Guideline for Reporting Systematic Reviews. BMJ. 2021; 29;372: n71. van Valkenhoef G, Lu G, de Brock B, et al. Automating network meta-analysis. Res Synth Methods. 2012;3(4):285–99. Pece A, Milani P, Monteleone C, et al. A randomized trial of intravitreal bevacizumab vs. ranibizumab for myopic CNV. Graefes Arch Clin Exp Ophthalmol. 2015; 253(11): 1867–72. Gharbiya M, Giustolisi R, Allievi F, et al. Choroidal Neovascularization in Pathologic Myopia: Intravitreal Ranibizumab Versus Bevacizumab—A Randomized Controlled Trial. Am J Ophthalmol. 2009;149(3): 458–464.e1. Howaidy A, Eldaly ZH. Comparison of structural and functional outcome of aflibercept versus ranibizumab in patients with myopic choroidal neovascularization. Eur J Ophthalmol. 2021; 31(1):211–217. Iacono P, Parodi MB, Papayannis A, et al. Intravitreal ranibizumab versus bevacizumab for treatment of myopic choroidal neovascularization. Retina. 2012;32(8):1539–46. Yasushi Ikuno et al. Intravitreal Aflibercept Injection in Patients with Myopic Choroidal Neovascularization. Ophthalmology. 2015; 122(6): 1220–1227. Parodi MB, Iacono P, Papayannis A, et al. Laser photocoagulation, photodynamic therapy, and intravitreal bevacizumab for the treatment of juxtafoveal choroidal neovascularization secondary to pathologic myopia. Arch Ophthalmol. 2010; 128(4): 437–442. Ruiz-Moreno JM, López-Gálvez MI, Montero Moreno JA, et al. Intravitreal Bevacizumab in Myopic Neovascular Membranes: 24-Month Results. Ophthalmology. 2013; 120(7): 1510–1511. Wolf S, Balciuniene VJ, Laganovska G, et al. RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia. Ophthalmology. 2014; 121(3): 682–692. Sayanagi K, Uematsu S, Hara C, et al. Effect of intravitreal injection of aflibercept or ranibizumab on chorioretinal atrophy in myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol. 2019 Apr;257(4):749–757. Lai TY, Luk FO, Lee GK, et al. Long-term outcome of intravitreal anti-vascular endothelial growth factor therapy with bevacizumab or ranibizumab as primary treatment for subfoveal myopic choroidal neovascularization. Eye (Lond). 2012;26(7):1004–11. Chen C, Yan M, Huang Z, et al. The Evaluation of a Two-Year Outcome of Intravitreal Conbercept versus Ranibizumab for Pathological Myopic Choroidal Neovascularization. Curr Eye Res. 2020;45(11):1415–1421. Cha DM, Kim TW, Heo JW, et al. Comparison of 1-year therapeutic effect of ranibizumab and bevacizumab for myopic choroidal neovascularization: a retrospective, multicenter, comparative study. BMC Ophthalmol. 2014;21; 14:69. Baba T, Kubota-Taniai M, Kitahashi M, et al. Two-year comparison of photodynamic therapy and intravitreal bevacizumab for treatment of myopic choroidal neovascularisation. Br J Ophthalmol. 2010;94(7):864–70. Ikuno Y, Nagai Y, Matsuda S, et al. Two-year visual results for older Asian women treated with photodynamic therapy or bevacizumab for myopic choroidal neovascularization. Am J Ophthalmol. 2010;149(1):140–6. Yoon JU, Byun YJ, Koh HJ. Intravitreal anti-VEGF versus photodynamic therapy with verteporfin for treatment of myopic choroidal neovascularization. Retina. 2010;30(3):418–24. Parravano M, Ricci F, Oddone F, et al. Long-term functional and morphologic retinal changes after ranibizumab and photodynamic therapy in myopic choroidal neovascularization. Retina. 2014;34(10):2053–62. Neelam K, Cheung CM, Ohno-Matsui K, et al. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res. 2012;31(5):495–525. Kojima A, Ohno-Matsui K, Teramukai S, et al. Estimation of visual outcome without treatment in patients with subfoveal choroidal neovascularization in pathologic myopia. Graefes Arch Clin Exp Ophthalmol. 2006;244(11):1474–9. Virgili G, Menchini F. Laser photocoagulation for choroidal neovascularisation in pathologic myopia. Cochrane Database Syst Rev. 2005;19;(4):CD004765. El Matri L, Chebil A, Kort F. Current and emerging treatment options for myopic choroidal neovascularization. Clin Ophthalmol. 2015; 24;9:733 – 44. Blinder KJ, Blumenkranz MS, Bressler NM, et al. Verteporfin therapy of subfoveal choroidal neovascularization in pathologic myopia: 2-year results of a randomized clinical trial–VIP report no. 3. Ophthalmology. 2003;110(4):667–73. Cheung CMG, Arnold JJ, Holz FG, et al. Myopic Choroidal Neovascularization: Review, Guidance, and Consensus Statement on Management. Ophthalmology. 2017;124(11):1690–1711. Wang Q, Li T, Wu Z, et al. Novel VEGF decoy receptor fusion protein conbercept targeting multiple VEGF isoforms provide remarkable anti-angiogenesis effect in vivo. PLoS One. 2013;12;8(8):e70544. Nie X, Wang Y, Yi H, et al. Intravitreal conbercept for choroidal neovascularisation secondary to pathological myopia in a real-world setting in China: Intravitreal conbercept was safe and effective in treating myopic choroidal neovascularization. BMC Ophthalmol. 2021; 4;21(1):116. Di Antonio L, Toto L, Mastropasqua A, et al. Retinal vascular changes and aqueous humor cytokines changes after aflibercept intravitreal injection in treatment-naïve myopic choroidal neovascularization. Sci Rep. 2018;23;8(1):15631. Muñoz-Villegas P, Sanchez-Rios A, Quinonez-Alvarado MG, et al. Pharmacokinetics and Safety of an Intravitreal Humanized Anti-VEGF-A Monoclonal Antibody (PRO-169), a Biosimilar Candidate to Bevacizumab. J Exp Pharmacol. 2021;31;13:545–554. Woo SJ, Veith M, Hamouz J, et al. Efficacy and Safety of a Proposed Ranibizumab Biosimilar Product vs a Reference Ranibizumab Product for Patients With Neovascular Age-Related Macular Degeneration: A Randomized Clinical Trial. JAMA Ophthalmol. 2021;1;139(1):68–76. Tables First author (year) Type Clinical trial Therapeutic method Eyes Change of FCT(μm) Follow-up time(months) Change of BCVA (logMAR) Follow-up time(months) Pece2015 19 RCT two arms IVB IVR 40 38 47±65.9 42.4±71.1 12 12 0.01±0.335 -0.12±0.355 19 19 Gharbiya2010 20 RCT two arms IVR IVB 16 16 45±64.9 52±42.7 6 6 -0.3±0.222 -0.32±0.168 12 12 Howaidy2019 21 RCT two arms IVA IVR 24 24 153.2±77.9 142.2±93.9 3 3 -0.15±0.121 -0.16±0.225 3 3 Iacono2012 22 RCT two arms IVR IVB 23 25 65±106.3 35±73.0 3 1 -0.19±0.195 -0.17±0.195 12 12 Ikuno2015 23 RCT two arms IVA Sham/IVA 90 31 - - - - -0.27±0.18 -0.08±0.18 12 12 Parodi2010 24 RCT three arms LT PDT IVB 17 18 19 - - - - - - 0.02±0.320 0.15±0.320 -0.2±0.320 12 12 12 Ruiz2013 25 RCT two arms PDT IVB 24 25 14±67.2 53±70.4 24 12 0.01±0.337 -0.22±0.304 12 12 Wolf2014 26 RCT two arms PDT IVR 55 116 - - - - -0.19±0.227 -0.28±0.204 12 12 Sayanagi2019 27 Retro two arms IVA IVR 15 12 141.3±110.5 94.8±103.8 12 12 -0.3±0.4100 -0.22±0.463 12 12 Lai2012 28 Retro two arms IVB IVR 22 15 - - - - -0.31±0.393 -0.55±0.441 12 12 Chen2020 29 Retro two arms IVC IVR 31 33 30.62±80.9 42.13±85.2 12 12 -0.41±0.508 -0.32±0.400 12 12 Cha2014 30 Retro two arms IVR IVB 22 42 - - - - -0.24±0.410 -0.21±0.410 12 12 Baba2010 31 Retro two arms PDT IVB 12 12 96±86.9 82±46.0 12 12 0.03±0.291 -0.26±0.394 12 12 Iruno2010 32 Retro two arms PDT IVB 20 11 - - - - 0.16±0.335 -0.19±0.318 12 12 Yoon2010 33 Retro three arms PDT IVR / IVB PDT with IVR/IVB 51 63 28 - - - - - - -0.06±0.474 -0.24±0.450 -0.09±0.482 12 12 12 Parravano2014 34 Retro two arms PDT IVR 43 42 65.8±107.8 93.7±120.1 12 13 -0.01±0.485 -0.13±0.331 12 12 Table1. Characteristics of the table. Note: Retro: Retrospective study; Sham/IVA: The patients were treated with IVA after sham treatment; IVR or IVB: Treatment with IVB or IVR; PDT with IVR or IVB: PDT was used in combination with IVB or IVR. LT -0.03 (-0.36, 0.26) PDT 0.15 (-0.28, 0.60) 0.17 (-0.14, 0.57) IVA 0.15 (-0.16, 0.47) 0.18 (0.02, 0.40) -0.00 (-0.33, 0.33) IVB 0.16(-0.18, 0.49) 0.18 (0.01, 0.42) 0.00 (-0.29, 0.30) 0.00 (-0.15, 0.17) IVR -0.05 (-0.57, 0.49) -0.02 (-0.44, 0.49) -0.19 (-0.48, 0.10) -0.19 (-0.64, 0.24) -0.20 (-0.62, 0.21) sham/IVA Table 2. Different treatment methods improve the results of a meta-analysis of BCVA mesh (RCT). Name Direct Effect Indirect Effect Overall P-Value PDT, IVR -0.10(-0.32,0.13) -0.33(-0.57, -0.09) -0.18(-0.42, -0.01) 0.11 PDT, IVB -0.28(-0.48, -0.09) -0.05 (-0.31, 0.22) -0.18(-0.40, -0.02) 0.1 IVB, IVR -0.05 (-0.20, 0.10) 0.19 (-0.12, 0.49) -0.00 (-0.17, 0.15) 0.11 Table 3 . The consistency of direct comparison and indirect comparison of various treatment methods with BCVA change as the node (RCT). Treatment Rank 1 Rank 2 Rank 3 Rank 4 Rank 5 Rank 6 LT 0.27 0.25 0.24 0.11 0.06 0.08 PDT 0.28 0.43 0.23 0.04 0.01 0.00 IVA 0.01 0.07 0.13 0.25 0.18 0.36 IVB 0.00 0.02 0.12 0.28 0.32 0.26 IVR 0.00 0.02 0.08 0.27 0.38 0.25 Sham/IVA 0.44 0.22 0.20 0.05 0.06 0.04 Table 4. Effect ranking diagram of different treatment methods to improve BCVA (RCT). Note: Rank1-6 corresponds to the color from light to dark in the ranking diagram; The higher the value, in the Rank6 on behalf of the treatment the better the results. IVA 12.8 (-56.7, 84.2） IVB 10.9 (-52.1, 73.3) 10.9 (-52.1, 73.3) IVR 52.0(-35.9, 141.8) 39.0 (-15.1, 93.8 40.8 (-20.9, 105.7) PDT Table 5. Different treatment methods improve the results of a meta-analysis of FCT mesh (RCT). Treatment Rank 1 Rank 2 Rank 3 Rank 4 IVA 0.57 0.13 0.21 0.09 IVB 0.19 0.37 0.41 0.03 IVR 0.21 0.46 0.29 0.04 PDT 0.03 0.04 0.10 0.84 Table 6. Effect ranking diagram of different treatment methods to improve FCT (RCT). Note: Rank1-4 corresponds to the color from dark to light in the ranking diagram; The higher the value, in the Rank1 on behalf of the treatment the better the results. IVA -0.12 (-0.68, 0.43) IVB -0.17 (-0.87, 0.52) -0.05 (-0.54, 0.43) IVB or IVR 0.00 (-0.63, 0.65) 0.13 (-0.36, 0.64) 0.16 (-0.47, 0.85) IVC -0.09 (-0.56, 0.40) 0.03 (-0.23, 0.30) 0.07 (-0.40, 0.61) -0.10 (-0.51, 0.32) IVR -0.34 (-0.92, 0.22) -0.22 (-0.50, 0.03) -0.18 (-0.58, 0.22) -0.34 (-0.89, 0.14) -0.25 (-0.57, 0.02) PDT -0.31 (-1.03, 0.38) -0.19 (-0.70, 0.30) -0.15 (-0.56, 0.28) -0.32 (-1.01, 0.33) -0.22 (-0.77, 0.28) 0.04 (-0.40, 0.46) PDT with IVB or IVR Table 7. Different treatment methods improve the results of a meta-analysis of BCVA mesh (Retrospective studies). Treatment Direct Effect Indirect Effect Overall P-Value IVB, IVR -0.12 (-0.42, 0.17) 0.20 (-0.29, 0.69) -0.03 (-0.30, 0.23) 0.2 IVB, PDT 0.32 (0.02, 0.62) 0.00 (-0.47, 0.49) 0.22 (-0.03, 0.50) 0.21 IVR, PDT 0.12 (-0.28, 0.52) 0.44 (0.02, 0.89) 0.25 (-0.02, 0.57) 0.21 Table 8. The consistency of direct comparison and indirect comparison of various treatment methods with BCVA change as the node (Retrospective studies). Treatment Rank 1 Rank 2 Rank 3 Rank 4 Rank 5 Rank 6 Rank7 IVA 0.06 0.06 0.07 0.10 0.11 0.20 0.39 IVB 0.01 0.09 0.17 0.30 0.22 0.15 0.06 IVB/IVR 0.06 0.13 0.30 0.14 0.12 0.14 0.11 IVC 0.04 0.05 0.06 0.10 0.13 0.26 0.36 IVR 0.01 0.04 0.12 0.23 0.35 0.21 0.04 PDT 0.45 0.36 0.14 0.03 0.01 0.00 0.00 PDT with IVB/IVR 0.37 0.28 0.14 0.08 0.06 0.05 0.02 Table 9. Effect ranking diagram of different treatment methods to improve BCVA (Retrospective studies). Note: Rank1-7 corresponds to the color from light to dark in the ranking diagram; The higher the value, in the Rank7 on behalf of the treatment the better the results. IVA 87.53 (-50.44, 236.33) IVB 57.26 (-66.20, 174.77) -31.11 (-160.84, 94.04) IVC 47.49 (-51.45, 145.05) -40.26 (-146.93, 63.59) -9.06 (-76.84, 60.22) IVR 75.91 (-43.26, 195.48) -12.96 (-93.66, 62.15) 18.37 (-78.26, 117.16) 26.75 (-41.75, 95.99) PDT Table 10. Different treatment methods improve the results of a meta-analysis of FCT mesh (Retrospective studies). Treatment Rank 1 Rank 2 Rank 3 Rank 4 Rank 5 IVA 0.74 0.11 0.08 0.04 0.03 IVB 0.06 0.11 0.11 0.20 0.53 IVC 0.10 0.26 0.28 0.17 0.18 IVR 0.07 0.42 0.35 0.12 0.03 PDT 0.03 0.10 0.18 0.47 0.22 Table 11. Effect ranking diagram of different treatment methods to improve FCT (Retrospective studies). Note: Rank1-5 corresponds to the color from dark to light in the ranking diagram; The higher the value, in the Rank1 on behalf of the treatment the better the results. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1988277","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":136824911,"identity":"4d8804c1-57c2-48fd-9a62-61023c6f5b6b","order_by":0,"name":"Yajun Wu","email":"","orcid":"","institution":"Central South University","correspondingAuthor":false,"prefix":"","firstName":"Yajun","middleName":"","lastName":"Wu","suffix":""},{"id":136824912,"identity":"d0176a07-63ad-41e6-9266-cde0fada3b83","order_by":1,"name":"Yuliang Feng","email":"","orcid":"","institution":"Central South University","correspondingAuthor":false,"prefix":"","firstName":"Yuliang","middleName":"","lastName":"Feng","suffix":""},{"id":136824913,"identity":"8e2a3e0b-0f65-4e08-83d7-d4bdc81c99c7","order_by":2,"name":"Jiasong Yang","email":"","orcid":"","institution":"Central South University","correspondingAuthor":false,"prefix":"","firstName":"Jiasong","middleName":"","lastName":"Yang","suffix":""},{"id":136824914,"identity":"c9d6bd24-f434-4d7c-b59a-f9126511045b","order_by":3,"name":"Hua Fan","email":"","orcid":"","institution":"Shanghai Aier ophthalmology hospital","correspondingAuthor":false,"prefix":"","firstName":"Hua","middleName":"","lastName":"Fan","suffix":""},{"id":136824915,"identity":"875e8cdb-de6d-4cbb-846d-81016a05879c","order_by":4,"name":"Zitong Yu","email":"","orcid":"","institution":"Shanghai Aier ophthalmology hospital","correspondingAuthor":false,"prefix":"","firstName":"Zitong","middleName":"","lastName":"Yu","suffix":""},{"id":136824916,"identity":"94bb7bf3-97af-49d8-936a-99e6cc2ee3cf","order_by":5,"name":"Xiaolin Xie","email":"","orcid":"","institution":"Shanghai Aier ophthalmology hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaolin","middleName":"","lastName":"Xie","suffix":""},{"id":136824917,"identity":"ad32c3e1-11b6-4be9-9614-ca6bfb144cea","order_by":6,"name":"Yumeng Dai","email":"","orcid":"","institution":"Shanghai Aier ophthalmology hospital","correspondingAuthor":false,"prefix":"","firstName":"Yumeng","middleName":"","lastName":"Dai","suffix":""},{"id":136824918,"identity":"6496e4de-a7ef-47d4-b204-9eef2a6bd491","order_by":7,"name":"Wensheng Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAkElEQVRIiWNgGAWjYDCCA8wNDAwVpGlhBGo5Q7IWxjZSdPDdPtgm+XOetWwD++GjG4jSInkusU2ad1u6cQNPWtoNorQYnGFsu8247XBigwSPGfFabv6cQ6qWG7wNpGiRPMPY/pvnWLpxG9F+4TvDfNjwR421bD/74WPEaYECZtKiBqKlgVQto2AUjIJRMHIAAH7nMhpOsJ9uAAAAAElFTkSuQmCC","orcid":"","institution":"Central South University","correspondingAuthor":true,"prefix":"","firstName":"Wensheng","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2022-08-23 03:29:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1988277/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1988277/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":26585223,"identity":"9b27bc15-fca6-493e-8311-dc2547db9068","added_by":"auto","created_at":"2022-09-16 21:18:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":118733,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow chart of literature search and screening.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-1988277/v1/d9ddf60b6ebe8a3d24bb3db9.png"},{"id":26585222,"identity":"3b4cce54-668f-43ac-96cc-3500a4c17587","added_by":"auto","created_at":"2022-09-16 21:18:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":47261,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNetwork diagram of different interventions.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote: A\u003c/strong\u003e, a network diagram of different treatment methods improving BCVA results in RCTs; \u003cstrong\u003eB\u003c/strong\u003e, a network diagram of different treatments improving BCVA outcomes in retrospective studies; \u003cstrong\u003eC\u003c/strong\u003e, a network diagram of different treatment methods improving FCT outcomes in RCTs; \u003cstrong\u003eD\u003c/strong\u003e, a network diagram of different treatments improving FCT outcomes in retrospective studies.\u003c/p\u003e\n\u003cp\u003eshamIVA refers to IVA treatment followed by sham treatment; IVBIVR refers to patients undergoing IVB or IVR treatment; PDTIVBIVR refers to patients receiving PDT combined with IVB or IVR treatment.\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-1988277/v1/5ae922e3833215948e6bff3a.png"},{"id":26585835,"identity":"5ae11af6-2dfc-4b31-b25b-943b9585e829","added_by":"auto","created_at":"2022-09-16 21:23:12","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":50871,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEffect ranking diagram of different treatment methods to improve BCVA (RCT).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote: \u003c/strong\u003eThe deeper the color on behalf of the treatment the better the results.\u003c/p\u003e","description":"","filename":"figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-1988277/v1/aed71e207614afbd55a81008.png"},{"id":26585998,"identity":"c1622208-5b8f-45e5-87ab-76d16bb39d81","added_by":"auto","created_at":"2022-09-16 21:28:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":58902,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEffect ranking diagram of different treatment methods to improve FCT (RCT).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote: \u003c/strong\u003eThe deeper the color on behalf of the treatment the better the results.\u003c/p\u003e","description":"","filename":"figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-1988277/v1/fa4f926ab0701a43da7abb6f.png"},{"id":26585226,"identity":"e243b92f-0556-432c-bae3-2f39e4c98f04","added_by":"auto","created_at":"2022-09-16 21:18:12","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":44042,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEffect ranking diagram of different treatment methods to improve BCVA (Retrospective studies).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote: \u003c/strong\u003eThe deeper the color on behalf of the treatment the better the results.\u003c/p\u003e","description":"","filename":"figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-1988277/v1/b23afb625838cd5646772cfc.png"},{"id":26585224,"identity":"8ba2bdd9-4b35-48f9-98a2-04d7a8e4ef5f","added_by":"auto","created_at":"2022-09-16 21:18:11","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":51285,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEffect ranking diagram of different treatment methods to improve FCT (Retrospective studies).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote: \u003c/strong\u003eThe deeper the color on behalf of the treatment the better the results.\u003c/p\u003e","description":"","filename":"figure6.png","url":"https://assets-eu.researchsquare.com/files/rs-1988277/v1/fcd3f1ad0ff3da0dfcc24669.png"},{"id":29182432,"identity":"9d2febb6-02d1-4843-8725-cf54a2ca5c48","added_by":"auto","created_at":"2022-11-17 11:44:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1031154,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1988277/v1/badfe183-9f90-48c8-9f18-0a4c958adbe8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Different approaches for the treatment of myopic choroidal neovascular: a network meta-analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAt present, myopia has become a global public health problem,\u003csup\u003e \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e \u003c/sup\u003e as the main cause of the uncorrected refractive error, which has brought a huge economic burden every year.\u003csup\u003e \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e \u003c/sup\u003e A meta-analysis shows that the global potential productivity loss caused by uncorrected myopia was estimated to be \u003cspan\u003e$\u003c/span\u003e244\u0026nbsp;billion in 2015.\u003csup\u003e \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e \u003c/sup\u003e High myopia (HM) is defined as ametropia with a diopter (D) \u0026le;-6 or less.\u003csup\u003e \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e \u003c/sup\u003e Moreover, HM was associated with a significant increase in visual impairment (VI), irreversible blindness,\u003csup\u003e \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e \u003c/sup\u003e and, more frightening still, a significant prevalence. According to a meta-analysis, nearly half of the world's population may suffer from myopia by 2050, of which the HM population will be as high as 10%.\u003csup\u003e6\u003c/sup\u003e Usually, while HM individuals have characteristic fundus pathological changes such as leopard-shaped fundus and chorioretinal atrophy, we call it pathological myopia (PM),\u003csup\u003e \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e \u003c/sup\u003e though there is no broad and clear clinical definition of the latter. Furthermore, compared with ordinary myopia, HM significantly increases the risk of complications caused by PM, such as retinal atrophy, retinal detachment (RD), cataract, glaucoma, myopic macular degeneration, and myopic choroidal neovascular (mCNV).\u003csup\u003e \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e \u003c/sup\u003e \u003c/p\u003e \u003cp\u003emCNV is one of the terrible complications from PM, affecting about 5\u0026ndash;11% of PM patients, of which about 15% involve both eyes.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e The disease mainly refers to the formation of abnormal neovascularization under the retinal pigment epithelium or retina.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Besides, the vision of patients who have not been treated for a long time will be significantly reduced or even blind.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Therefore, timely treatment of mCNV is very important. Currently, there are several treatments for mCNV, including retinal laser photocoagulation, photodynamic therapy (PDT), intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs, etc. All of them have been shown to be effective in the treatment of mCNV. Matsuda et al. found that after laser treatment (LT), mCNV patients were followed up for 13\u0026ndash;60 months, despite the phenomenon of laser photocoagulation scar enlargement in about 80% of patients, almost all patients had no vision loss and were well-controlled.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Also, PDT was shown to improve visual acuity in patients with mCNV during a one-year follow-up.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e In addition, with the emergence of anti-VEGF drugs and successful application in many other retinal angiogenic diseases, anti-VEGF therapy has gradually become a common treatment for mCNV. Currently, commonly used anti-VEGF drugs include aflibercept, ranibizumab, bevacizumab, and conbercept (which was produced in China and was approved by the State Food and Drug Administration of China in May 2017 for the treatment of mCNV).\u003c/p\u003e \u003cp\u003eAlthough there have been meta-analyses on mCNV. But they are mainly traditional meta-analyses comparing two treatment methods. For example, Hu et al.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e compared the efficacy of intravitreal bevacizumab (IVB) and ranibizumab (IVR) in the treatment of mCNV in a meta-analysis and confirmed that both of them were effective treatment measures, though there was no statistical difference between the two treatments as far as possible. Additionally, Wang et al.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e compared the ranibizumab/bevacizumab with PDT treatment and found that anti-VEGF on mCNV treatment has a better curative effect. However, so far, no mesh meta-analysis has comprehensively compared various treatment methods and the four different anti-VEGF drugs. Therefore, the purpose of this study is to compare and rank the efficacy of several existing mCNV treatment methods, in order to obtain the best method of mCNV treatment and provide useful information for guiding the clinical treatment of the disease.\u003c/p\u003e"},{"header":"Results","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eFlow chart and characteristic table\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e1.1Literature search results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe preliminarily searched 763 articles, deleted 61 duplicate articles, 617 non-comparative original articles were deleted, excluded 56 articles by reading the title and abstract, excluded 13 articles after reading the full text, and finally included 16 articles that met the criteria. Details are presented in Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 Basic characteristics of the included study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 16 articles were included, including 8 RCTs and 8 retrospective studies, involving 1072 eyes. The following is the characteristic table of the original literature (Table 1)\u003c/p\u003e\n\u003col start=\"2\"\u003e\n\u003cli\u003e\u003cstrong\u003eEvidence network diagram\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eFigure 2A shows the network diagram of 6 different mCNV treatment methods in the BCVA results of RCTs, a total of 6 interventions including IVA, IVR, IVB, PDT, LT, and sham-combined IVA were involved in the mesh meta-analysis; Figure 2B shows the network relationship diagram of different treatment methods for mCNV in the BCVA results from retrospective studies, the mesh meta-analysis involves 7 interventions: IVA, IVR, IVB, IVC, IVB or IVR treatment, PDT treatment alone, and PDT combined with IVB or IVR treatment; Figure 2C shows a network diagram of 4 different treatments(IVB, IVR, IVA, PDT) in RCTs of FCT results. Figure 2D shows a network diagram of 5 different treatments (IVA, IVB, IVC, IVR, PDT) in the FCT results of retrospective studies; The line thickness in the figure is positively correlated with the number of studies directly comparing the two interventions.\u003c/p\u003e\n\u003col start=\"3\"\u003e\n\u003cli\u003e\u003cstrong\u003eThe convergence and stability evaluation results of the study were included\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe convergence diagnosis diagram and trajectory density diagram are drawn to evaluate the convergence and stability of the model. Before 50000 iterations of the model, the convergence diagnosis diagram and trajectory diagram have converged. The density diagram is a curve with a normal shape and smooth distribution, and the bandwidth value approaches 0, suggesting that the convergence degree of the model is satisfactory and the stability is good.\u003c/p\u003e\n\u003col start=\"4\"\u003e\n\u003cli\u003e\u003cstrong\u003eResults of mesh meta-analysis\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 RCTs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1.2 Results of BCVA changes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the 8 articles included, the changes in BCVA in patients were described. In the included study, a significant increase in BCVA from baseline after most treatments were observed. A comprehensive analysis was carried out using Addis and R software\u003c/p\u003e\n\u003cp\u003eThe results of mesh meta-analysis showed that: BCVA improvement after IVB and IVR treatment was better than PDT [MD=0.18, 95%CI (0.02, 0,40)], [MD=0.18, 95%CI (0.01, 0.42)]. There was no statistical significance in the comparison of postoperative hospital stay between other closure methods (The 95%CI contains 0, which means it is not statistically significant), as shown in Table 2.\u003c/p\u003e\n\u003cp\u003eNode analysis showed that all P \u0026gt; 0.05, reflecting that there was no statistical inconsistency between the results of direct comparison and indirect comparison. See Table3 for the detailed results.\u003c/p\u003e\n\u003cp\u003eADDIS and R showed that the order of probability of improving visual acuity by mCNV treatment was IVA\u0026gt;IVB\u0026gt;IVR\u0026gt;LT\u0026gt; Sham /IVA\u0026gt;PDT, See Figure 3 and Table 4 for details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1.2 Results of FCT changes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong all RCTs, there are 5 articles involving the change of FCT results, including IVB, IVA, IVR, and PDT. We extracted the data on FCT changes before and after mCNV treatment and found that these treatment methods have no statistical difference in reducing FCT. The detailed results are shown in Table 5(The 95%CI contains 0, which means it is not statistically significant); The results of the comparison and ranking of the effects of these four treatment methods show that IVA may have the best effect, followed by IVR and IVB, and PDT may have the worst effect. The detailed results are shown in Figure 4 and Table 6.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2\u003c/strong\u003e \u003cstrong\u003eRetrospective studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.1 Results of BCVA changes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 8 included articles described BCVA changes after 12 months of treatment. Addis combined with R software was used for comprehensive analysis, Mesh meta results showed no statistical difference among all treatments (95%CI includes 0), See Table 7 for details.\u003c/p\u003e\n\u003cp\u003eThe node analysis method shows that the direct comparison results are consistent with the indirect comparison results (P \u0026gt; 0.05). See table 8 for the details.\u003c/p\u003e\n\u003cp\u003eADDIS combined with R shows that after 12 months of treatment with 7 different methods, the order of increasing the probability of BCVA in mCNV patients is IVA \u0026gt; IVC \u0026gt; IVR or IVB \u0026gt; IVB \u0026gt; IVR \u0026gt; PDT with IVB or IVR \u0026gt; PDT. See Figure 5 and Table 9 for details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.2 Results of FCT changes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 4 retrospective studies involved the changes in FCT results, including IVC, IVB, IVA, IVR, and PDT. We found that these treatment methods had no statistical difference in reducing FCT. The detailed results are shown in table 10; The results of the comparison and ranking of the effects of these five treatment methods show that IVA may have the best effect, followed by IVC, IVR, IVB, and PDT may have the worst effect. See Figure 6 and Table 11 for the detailed results.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn order to comprehensively compare the efficacy of different anti-VEGF drugs, PDT, LT, and even several combination therapy methods, we initially tried to include only RCTs. However, due to the lack of statistically significant results after the combination of all appropriate RCTs, considering the limited current RCTs, therefore, we also conducted the same mesh meta-analysis on retrospective articles in order to find the most suitable clinical treatment method for mCNV, and the results were similar to RCTs. This is the first article to compare the efficacy of different mCNV treatment methods in RCTs and retrospective studies, involving a total of 16 articles. The results of both RCTs and retrospective studies showed that anti-VEGF therapy might be the best choice after a long-term treatment follow-up of about 12 months. According to the sequencing results, since most of the results showed no statistical significance, we could only get the best possible treatment. The results of RCT and retrospective studies show that among anti-VEGF drugs, IVA may have the best effect in restoring the structure and function of mCNV patients. However, due to the lack of statistical significance, this result is only a possible reference, and more literature and higher-quality data are needed to further confirm this result.\u003c/p\u003e \u003cp\u003emCNV is one of the complications of myopia with severe loss of vision.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Patients without timely treatment will have very poor vision.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e For a long time in the past, laser therapy has been used to treat CNV, but it is limited to extrafoveal mCNV and not applicable to subfoveal mCNV. This treatment is prone to laser scar expansion and disease recurrence.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e In our study, there is only one article involving LT,\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e and due to the small sample size, it only shows that the degree of vision decline of patients is better than PDT treatment, which has no great advantage in improving visual acuity.\u003c/p\u003e \u003cp\u003eMoreover, the first approved mCNV method that could be used in the treatment is PDT. In fact, as early as 2001, a clinical study of mCNV treated 81 eyes with PDT and 39 eyes with glucose for sham treatment for 12 months, finally, it was found that compared with the control group, the visual acuity of mCNV patients treated with PDT tended to be stable or even improved, and there were no obvious adverse reactions, which proved that PDT can be used as an effective treatment for mCNV.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e However, when followed up to 24 months, the visual acuity of the PDT treatment group was no longer significantly improved compared with the placebo control group, which can be said to be mainly manifested as stable visual acuity, which may be caused by PDT treatment exacerbating the development of choroidal retinal atrophy in myopia patients.\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e What`s more, all the articles included in our study that involved PDT treatment were followed up for 12 months, but there were different evaluations on its efficacy. Some studies\u0026rsquo; results showed that the BCVA of mCNV patients improved, while others decreased. We speculated that this was related to the small sample size. After all, studies\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e,\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e with a large sample size all showed that BCVA could be improved after 12 months of PDT treatment.\u003c/p\u003e \u003cp\u003eIntravitreal injection of anti-VEGF drugs is considered the first-line treatment of mCNV,\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e also, at the same time, it is the most economic burden of the treatment method. Conbercept is a new anti-VEGF drug from China, like aflibercept, it is a soluble receptor protein. The difference is that conbercept mainly contains extracellular domain 2 of VEGF receptor 1 and extracellular domains 3 and 4 of VEGF receptor 2, which are fused with Fc part of human immunoglobulin G1,\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e while aflibercept only contains extracellular domain 2 of human VEGF receptor 1.\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e The efficacy and safety of IVC in the treatment of mCNV have been verified. In a retrospective study in China, 34 mCNV eyes were treated with conbercept and followed up for 12 months. The logMAR BCVA of the patients increased by 4.12\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69 on average without complications or adverse events.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e As with other anti-VEGF drugs, it can be used as a long-term therapeutic agent for mCNV, although its application is limited at present, especially in other countries. Furthermore, aflibercept has been used earlier for the treatment of mCNV, which has also been demonstrated a significant therapeutic effect. Luca et al. performed IVA treatment on 15 eyes of mCNV patients and finally found that the patients not only improved BCVA but also significantly reduced central retinal thickness, as well as decreased levels of vascular endothelial growth factor (VEGF) and placental growth factor (PIGF).\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e Besides, bevacizumab is a humanized monoclonal antibody (IgG1) targeting VEGF-A to inhibit angiogenesis, in addition, it is mainly composed of a fab region that binds to the target and an Fc region that performs an effector function.\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e What's more, ranibizumab is also a humanized monoclonal antibody fragment, but it only contains Fab fragment, which can also inhibit VEGF-A and prevent the formation of new blood vessels.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e As one of the most commonly used anti-VEGF drugs, ranibizumab, and bevacizumab are commonly used to compare efficacy with each other, but they are currently considered to have the same efficacy in improving visual acuity in mCNV patients without statistical difference.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Thus, the four kinds of VEGF drugs can effectively inhibit the formation of new blood vessels, for the treatment of mCNV hope, but actually what drug effects best is yet to be concluded. Even in this study we just draw in the RCT group that IVB, IVR is superior to the PDT treatment, 4 kinds of anti-VEGF drugs between concrete and also did not have statistically significant results, we think that is likely to be factors such as literature insufficiency, the sample size is too little.\u003c/p\u003e \u003cp\u003eThere are several deficiencies in our study. First of all, we want to compare the long-term efficacy of different treatments, so we tried to choose 12 months as a follow-up time. However, only the data in retrospective studies meet the conditions of time unification. In RCTs, there are still two studies with BCVA results followed up for 3 months and 19 months respectively. As for the results of FCT, the data in most articles do not meet the follow-up time of 12 months. Secondly, we only selected the reduction of LogMAR BCVA, and FCT as the outcome index, because most of the included articles only included these indexes, and the changes in visual acuity and FCT are the most important indexes to evaluate the efficacy of mCNV. We tried to include the number of anti-VEGF injections as the outcome index, but the data included in the study is difficult to meet the extraction of this index. Finally, there are too few studies included in this study and the sample size is not large, which is why most of the results in this study are not statistically significant. In the future, we hope that there will be more appropriate studies, and we will update the data in time to get more reliable results.\u003c/p\u003e \u003cp\u003eAnti-VEGF is the most effective drug to improve the retinal structure and function of mCNV patients. However, PDT and laser also have certain therapeutic effects, and patients will not have a heavy economic burden. But, we have only obtained the possible ranking results of efficacy: Aflibercept may be the most effective anti-VEGF drug for the treatment of mCNV, the above results may only have reference significance. After all, there is no statistical difference in the therapeutic effect of four different anti-VEGF drugs. These conclusions need to be confirmed by higher quality and larger sample studies.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cstrong\u003eProtocol and registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has been pre-registered in the International Prospective Register of Systematic Reviews under the registration number PROSPERO (https://www.crd.york.ac.uk/prospero/): CRD42021287142.\u0026nbsp;This network meta-analysis was conducted and presented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSearch Strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn order to obtain appropriate randomized controlled trials (RCTs) and retrospective articles as far as possible, we searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, and other databases, the retrieval time limit is from the establishment of each database to November 30, 2021. The language of this article is limited to English, and the retrieval strategy is \u0026ldquo;myopia\u0026rdquo; AND \u0026ldquo;choroid neovascularization\u0026rdquo; OR \u0026ldquo;mCNV\u0026rdquo; AND \u0026ldquo;pathological myopia\u0026rdquo; OR \u0026ldquo;PM\u0026rdquo; AND \u0026ldquo;photodynamic therapy\u0026rdquo; OR \u0026ldquo;PDT\u0026rdquo; OR \u0026ldquo;anti-VEGF\u0026rdquo; OR \u0026ldquo;bevacizumab\u0026rdquo; OR \u0026ldquo;IVB\u0026rdquo; OR \u0026ldquo;aflibercept\u0026rdquo; OR \u0026ldquo;IVA\u0026rdquo; OR \u0026ldquo;ranibizumab\u0026rdquo; OR \u0026ldquo;IVR\u0026rdquo; OR \u0026ldquo;conbercept\u0026rdquo; OR \u0026ldquo;IVC\u0026rdquo; OR \u0026ldquo;laser treatment\u0026rdquo; OR \u0026ldquo;laser photocoagulation\u0026rdquo; OR \u0026ldquo;mCNV\u0026rdquo; AND \u0026ldquo;randomized controlled trials\u0026rdquo; OR \u0026ldquo;RCT\u0026rdquo; OR \u0026ldquo;retrospective studies\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe included and analyzed RCTs and retrospective studies respectively. These studies are comparative articles on different treatment methods for mCNV patients, mainly including the comparison of best-corrected visual acuity (BCVA) changes before and after treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInclusion criteria:1. mCNV patients (CNV patients secondary to PM: refractive error \u0026le; - 6.0 diopter, or axial length greater than 26 mm) received treatment, regardless of race, region, occupation, and age;2.\u0026nbsp;The data were complete, including baseline BCVA and post-treatment BCVA.3.\u0026nbsp;Comparison of the efficacy of at least two treatment methods.\u0026nbsp;Exclusion criteria: 1. Study subjects are not patients with CNV secondary to PM; 2. Single-arm study without a comparison of treatment measures. 3. Non-original articles such as summarization and experience summary; 4. Incomplete data or incomplete data cannot be obtained from the author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome was the mean change in BCVA after treatment from baseline, and the visual acuity was logarithmic visual acuity (logMAR) converted from BCVA measurements.\u0026nbsp;The secondary outcome measure was the change in foveal center thickness (FCT) on optical coherence tomography (OCT).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLiterature selection and data extraction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, two authors (Yuliang Feng and Jiasong Yang) independently read the title and abstract of the article according to the inclusion and exclusion criteria, exclude the articles that clearly do not meet the requirements, and then determine the final included literature by reading the content of the article in detail. If the two authors disagree in this process, they will consult or discuss and submit it to the third senior researcher for adjudication, Missing data were obtained by contacting the corresponding authors of the included literature.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eADDIS 1.16.8(http://www.drugis.org/ index) and R version 3.5.3\u003csup\u003e18\u003c/sup\u003e(R Foundation for Statistical Computing, Vienna, Austria) software were used to analyze the data. In this study, quantitative data and mean square deviation (MD) were used as the effect indicator, and the MD and standard deviation (SD) of each group of data were extracted for joint analysis. Point estimates and 95% confidence intervals (CI) of each effect indicator were given. \u0026chi;2 test (\u0026alpha;=0.1) was used to analyze the heterogeneity among the included studies, and I\u003csup\u003e2\u003c/sup\u003e was used to determine the heterogeneity. If the heterogeneity among the results was small, the fixed-effect model was used for meta-analysis. Otherwise, if the heterogeneity among the results was large, the random-effect model was used for meta-analysis after excluding the influence of obvious clinical heterogeneity, and P\u0026lt;0.05 between each group was considered statistically significant. ADDIS software was used to calculate the potential Scale reduction factor (PSRF) to diagnose the convergence degree of the model. Set the initial value of 4 Markov chains, the initial value of the model is 2.5, refine the iteration step size by 10, adjust the number of iterations by 20000 times, and simulate the number of iterations by 50000 times. Only when the PSRF value tends to 1 indicates that the convergence of the model is satisfactory.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe R software calls \u0026quot;RJAGS\u0026quot;, \u0026quot;GEMTC\u0026quot; program package to establish the Bayesian model, and calls \u0026quot;Network\u0026quot; program package to draw the evidence Network diagram of each intervention. The straight line indicates that there is direct comparison evidence between the two interventions, and the wireless connection lacks direct comparison evidence. The thicker the line, the more studies that directly compared the two interventions. The optimal probability ranking curve (SUCRA) value was calculated, the ranking map was drawn to predict the ranking of therapeutic effects of various measures, and the forest map for direct comparison was drawn. For the study of generating Node Split nodes, the Node Split model was first used to test the consistency of direct comparison and indirect comparison. P \u0026gt; 0.05 indicated good consistency and the consistency model was used for analysis. Instead, adopt the inconsistency model.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eYajun Wu: responsible for writing and modifying manuscripts; Yuliang Feng and Jiasong Yang: responsible for independent screening of literature; Hua Fan: responsible for data statistics and chart making; Zitong Yu, Xiaolin Xie and Yumeng Dai responsible for proofreading and revising the language of the manuscript; Wensheng Li: responsible for the design of the study and guiding the revision of manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Disclosures:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Sharing Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data in this study are used to support the results of this study and can be obtained at the request of the corresponding authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAier Eye Hospital Group Scientific Research Fund (AR2001D1).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMorgan IG, Ohno-Matsui K, Saw SM. Myopia. Lancet. 2012;379,9827:1739\u0026ndash;1748.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith TS, Frick KD, Holden BA, et al. Potential lost productivity resulting from the global burden of uncorrected refractive error. Bull World Health Organ. 2009;87(6):431\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaidoo KS, Fricke TR, Frick KD, et al. Potential Lost Productivity Resulting from the Global Burden of Myopia: Systematic Review, Meta-analysis, and Modeling. Ophthalmology.2018; 126(3):338\u0026ndash;346.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan IG, He MG, Rose KA. Epidemic of pathologic myopia: What Can Laboratory Studies and Epidemiology Tell Us? Retina. 2017; 37(5):989\u0026ndash;997.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerkicharla PK, Ohno-Matsui K, Saw SM. Current and predicted demographics of high myopia and an update of its associated pathological changes. Ophthalmic Physiol Optics.2015; 35(5):465e475.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016; 123(5): 1036\u0026ndash;1042.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeelam K, Cheung CM, Ohno-Matsui K, et al. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res.2012;31(5): 495\u0026ndash;525.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang Y, Lou S, Li Y, et al. High myopia and macular vascular density: an optical coherence tomography angiography study. BMC Ophthalmology. 2021; 21(1): 407\u0026ndash;407.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong TY, Ferreira A, Hughes R, et al. Epidemiology and disease burden of pathologic myopia and myopic choroidal neovascularization: An evidence-based systematic review. American Journal of Ophthalmology. 2014; 157(1): p. 9\u0026ndash;25.e12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIkuno Y. OVERVIEW OF THE COMPLICATIONS OF HIGH MYOPIA. Retina. 2017; 37(12): 2347\u0026ndash;2351.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang MC, Chen YP, Tan EC, et al. Epidemiology, treatment pattern and health care utilization of myopic choroidal neovascularization: a population based study. Jan J Ophthalmol.2017; 61(2): 159\u0026ndash;168.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKojima A, Ohno-Matsui K, Teramukai S, et al. Estimation of visual outcome without treatment in patients with subfoveal choroidal neovascularization in pathologic myopia. Graefes Arch Clin Exp Ophthalmol.2006; 244:1474\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsuda S, Harino S, Iwahashi Y, et al. Long-term enlargement of laser photocoagulation scars after treatment of choroidal neovascularization. Nippon Ganka Gakkai zasshi. 2002; 106(11): 708\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerteporfin in Photodynamic Therapy Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in pathologic myopia with verteporfin. 1-year results of a randomized clinical trial\u0026ndash;VIP report no. 1 Ophthalmology. 2001;108(5):841\u0026ndash;852.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu Q, Li H, Du Y, et al. Comparison of intravitreal bevacizumab and ranibizumab used for myopic choroidal neovascularization: A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials. Medicine.2019; 98(12): e14905.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang E, Chen Y. Intravitreal anti-vascular endothelial growth factor for choroidal neovascularization secondary to pathologic myopia: systematic review and meta-analysis. Retina. 2013; 33(7): 1375\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePage MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 Statement: an Updated Guideline for Reporting Systematic Reviews. BMJ. 2021; 29;372: n71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Valkenhoef G, Lu G, de Brock B, et al. Automating network meta-analysis. Res Synth Methods. 2012;3(4):285\u0026ndash;99.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePece A, Milani P, Monteleone C, et al. A randomized trial of intravitreal bevacizumab vs. ranibizumab for myopic CNV. Graefes Arch Clin Exp Ophthalmol. 2015; 253(11): 1867\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGharbiya M, Giustolisi R, Allievi F, et al. Choroidal Neovascularization in Pathologic Myopia: Intravitreal Ranibizumab Versus Bevacizumab\u0026mdash;A Randomized Controlled Trial. Am J Ophthalmol. 2009;149(3): 458\u0026ndash;464.e1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHowaidy A, Eldaly ZH. Comparison of structural and functional outcome of aflibercept versus ranibizumab in patients with myopic choroidal neovascularization. Eur J Ophthalmol. 2021; 31(1):211\u0026ndash;217.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIacono P, Parodi MB, Papayannis A, et al. Intravitreal ranibizumab versus bevacizumab for treatment of myopic choroidal neovascularization. Retina. 2012;32(8):1539\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYasushi Ikuno et al. Intravitreal Aflibercept Injection in Patients with Myopic Choroidal Neovascularization. Ophthalmology. 2015; 122(6): 1220\u0026ndash;1227.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParodi MB, Iacono P, Papayannis A, et al. Laser photocoagulation, photodynamic therapy, and intravitreal bevacizumab for the treatment of juxtafoveal choroidal neovascularization secondary to pathologic myopia. Arch Ophthalmol. 2010; 128(4): 437\u0026ndash;442.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRuiz-Moreno JM, L\u0026oacute;pez-G\u0026aacute;lvez MI, Montero Moreno JA, et al. Intravitreal Bevacizumab in Myopic Neovascular Membranes: 24-Month Results. Ophthalmology. 2013; 120(7): 1510\u0026ndash;1511.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWolf S, Balciuniene VJ, Laganovska G, et al. RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia. Ophthalmology. 2014; 121(3): 682\u0026ndash;692.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSayanagi K, Uematsu S, Hara C, et al. Effect of intravitreal injection of aflibercept or ranibizumab on chorioretinal atrophy in myopic choroidal neovascularization. Graefes Arch Clin Exp Ophthalmol. 2019 Apr;257(4):749\u0026ndash;757.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLai TY, Luk FO, Lee GK, et al. Long-term outcome of intravitreal anti-vascular endothelial growth factor therapy with bevacizumab or ranibizumab as primary treatment for subfoveal myopic choroidal neovascularization. Eye (Lond). 2012;26(7):1004\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen C, Yan M, Huang Z, et al. The Evaluation of a Two-Year Outcome of Intravitreal Conbercept versus Ranibizumab for Pathological Myopic Choroidal Neovascularization. Curr Eye Res. 2020;45(11):1415\u0026ndash;1421.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCha DM, Kim TW, Heo JW, et al. Comparison of 1-year therapeutic effect of ranibizumab and bevacizumab for myopic choroidal neovascularization: a retrospective, multicenter, comparative study. BMC Ophthalmol. 2014;21; 14:69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaba T, Kubota-Taniai M, Kitahashi M, et al. Two-year comparison of photodynamic therapy and intravitreal bevacizumab for treatment of myopic choroidal neovascularisation. Br J Ophthalmol. 2010;94(7):864\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIkuno Y, Nagai Y, Matsuda S, et al. Two-year visual results for older Asian women treated with photodynamic therapy or bevacizumab for myopic choroidal neovascularization. Am J Ophthalmol. 2010;149(1):140\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoon JU, Byun YJ, Koh HJ. Intravitreal anti-VEGF versus photodynamic therapy with verteporfin for treatment of myopic choroidal neovascularization. Retina. 2010;30(3):418\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParravano M, Ricci F, Oddone F, et al. Long-term functional and morphologic retinal changes after ranibizumab and photodynamic therapy in myopic choroidal neovascularization. Retina. 2014;34(10):2053\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeelam K, Cheung CM, Ohno-Matsui K, et al. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res. 2012;31(5):495\u0026ndash;525.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKojima A, Ohno-Matsui K, Teramukai S, et al. Estimation of visual outcome without treatment in patients with subfoveal choroidal neovascularization in pathologic myopia. Graefes Arch Clin Exp Ophthalmol. 2006;244(11):1474\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVirgili G, Menchini F. Laser photocoagulation for choroidal neovascularisation in pathologic myopia. Cochrane Database Syst Rev. 2005;19;(4):CD004765.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Matri L, Chebil A, Kort F. Current and emerging treatment options for myopic choroidal neovascularization. Clin Ophthalmol. 2015; 24;9:733 \u0026ndash; 44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlinder KJ, Blumenkranz MS, Bressler NM, et al. Verteporfin therapy of subfoveal choroidal neovascularization in pathologic myopia: 2-year results of a randomized clinical trial\u0026ndash;VIP report no. 3. Ophthalmology. 2003;110(4):667\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheung CMG, Arnold JJ, Holz FG, et al. Myopic Choroidal Neovascularization: Review, Guidance, and Consensus Statement on Management. Ophthalmology. 2017;124(11):1690\u0026ndash;1711.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Q, Li T, Wu Z, et al. Novel VEGF decoy receptor fusion protein conbercept targeting multiple VEGF isoforms provide remarkable anti-angiogenesis effect in vivo. PLoS One. 2013;12;8(8):e70544.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNie X, Wang Y, Yi H, et al. Intravitreal conbercept for choroidal neovascularisation secondary to pathological myopia in a real-world setting in China: Intravitreal conbercept was safe and effective in treating myopic choroidal neovascularization. BMC Ophthalmol. 2021; 4;21(1):116.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Antonio L, Toto L, Mastropasqua A, et al. Retinal vascular changes and aqueous humor cytokines changes after aflibercept intravitreal injection in treatment-na\u0026iuml;ve myopic choroidal neovascularization. Sci Rep. 2018;23;8(1):15631.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMu\u0026ntilde;oz-Villegas P, Sanchez-Rios A, Quinonez-Alvarado MG, et al. Pharmacokinetics and Safety of an Intravitreal Humanized Anti-VEGF-A Monoclonal Antibody (PRO-169), a Biosimilar Candidate to Bevacizumab. J Exp Pharmacol. 2021;31;13:545\u0026ndash;554.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWoo SJ, Veith M, Hamouz J, et al. Efficacy and Safety of a Proposed Ranibizumab Biosimilar Product vs a Reference Ranibizumab Product for Patients With Neovascular Age-Related Macular Degeneration: A Randomized Clinical Trial. JAMA Ophthalmol. 2021;1;139(1):68\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eFirst author (year)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eType\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eClinical trial\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eTherapeutic method\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003eEyes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003eChange of FCT(\u0026mu;m)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003eFollow-up time(months)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003eChange of BCVA (logMAR)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003eFollow-up time(months)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003ePece2015\u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e47\u0026plusmn;65.9\u003c/p\u003e\n\u003cp\u003e42.4\u0026plusmn;71.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e0.01\u0026plusmn;0.335\u003c/p\u003e\n\u003cp\u003e-0.12\u0026plusmn;0.355\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eGharbiya2010\u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e45\u0026plusmn;64.9\u003c/p\u003e\n\u003cp\u003e52\u0026plusmn;42.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e-0.3\u0026plusmn;0.222\u003c/p\u003e\n\u003cp\u003e-0.32\u0026plusmn;0.168\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eHowaidy2019\u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIVA\u003c/p\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e153.2\u0026plusmn;77.9\u003c/p\u003e\n\u003cp\u003e142.2\u0026plusmn;93.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e-0.15\u0026plusmn;0.121\u003c/p\u003e\n\u003cp\u003e-0.16\u0026plusmn;0.225\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eIacono2012\u003csup\u003e22\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e65\u0026plusmn;106.3\u003c/p\u003e\n\u003cp\u003e35\u0026plusmn;73.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e-0.19\u0026plusmn;0.195\u003c/p\u003e\n\u003cp\u003e-0.17\u0026plusmn;0.195\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eIkuno2015\u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIVA\u003c/p\u003e\n\u003cp\u003eSham/IVA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e90\u003c/p\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e-0.27\u0026plusmn;0.18\u003c/p\u003e\n\u003cp\u003e-0.08\u0026plusmn;0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eParodi2010\u003csup\u003e24\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003ethree arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eLT\u003c/p\u003e\n\u003cp\u003ePDT\u003c/p\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e0.02\u0026plusmn;0.320\u003c/p\u003e\n\u003cp\u003e0.15\u0026plusmn;0.320\u003c/p\u003e\n\u003cp\u003e-0.2\u0026plusmn;0.320\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eRuiz2013\u003csup\u003e25\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePDT\u003c/p\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e14\u0026plusmn;67.2\u003c/p\u003e\n\u003cp\u003e53\u0026plusmn;70.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e0.01\u0026plusmn;0.337\u003c/p\u003e\n\u003cp\u003e-0.22\u0026plusmn;0.304\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eWolf2014\u003csup\u003e26\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRCT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePDT\u003c/p\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e55\u003c/p\u003e\n\u003cp\u003e116\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e-0.19\u0026plusmn;0.227\u003c/p\u003e\n\u003cp\u003e-0.28\u0026plusmn;0.204\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eSayanagi2019\u003csup\u003e27\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRetro\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIVA\u003c/p\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e141.3\u0026plusmn;110.5\u003c/p\u003e\n\u003cp\u003e94.8\u0026plusmn;103.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e-0.3\u0026plusmn;0.4100\u003c/p\u003e\n\u003cp\u003e-0.22\u0026plusmn;0.463\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eLai2012\u003csup\u003e28\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRetro\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e-0.31\u0026plusmn;0.393\u003c/p\u003e\n\u003cp\u003e-0.55\u0026plusmn;0.441\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eChen2020\u003csup\u003e29\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRetro\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIVC\u003c/p\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e30.62\u0026plusmn;80.9\u003c/p\u003e\n\u003cp\u003e42.13\u0026plusmn;85.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e-0.41\u0026plusmn;0.508\u003c/p\u003e\n\u003cp\u003e-0.32\u0026plusmn;0.400\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eCha2014\u003csup\u003e30\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRetro\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003cp\u003e42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e-0.24\u0026plusmn;0.410\u003c/p\u003e\n\u003cp\u003e-0.21\u0026plusmn;0.410\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eBaba2010\u003csup\u003e31\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRetro\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePDT\u003c/p\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e96\u0026plusmn;86.9\u003c/p\u003e\n\u003cp\u003e82\u0026plusmn;46.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e0.03\u0026plusmn;0.291\u003c/p\u003e\n\u003cp\u003e-0.26\u0026plusmn;0.394\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eIruno2010\u003csup\u003e32\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRetro\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePDT\u003c/p\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e0.16\u0026plusmn;0.335\u003c/p\u003e\n\u003cp\u003e-0.19\u0026plusmn;0.318\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eYoon2010\u003csup\u003e33\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRetro\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003ethree arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePDT\u003c/p\u003e\n\u003cp\u003eIVR / IVB\u003c/p\u003e\n\u003cp\u003ePDT with IVR/IVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e51\u003c/p\u003e\n\u003cp\u003e63\u003c/p\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003cp\u003e-\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e-0.06\u0026plusmn;0.474\u003c/p\u003e\n\u003cp\u003e-0.24\u0026plusmn;0.450\u003c/p\u003e\n\u003cp\u003e-0.09\u0026plusmn;0.482\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eParravano2014\u003csup\u003e34\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eRetro\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003etwo arms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"132\"\u003e\n\u003cp\u003ePDT\u003c/p\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003cp\u003e42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"151\"\u003e\n\u003cp\u003e65.8\u0026plusmn;107.8\u003c/p\u003e\n\u003cp\u003e93.7\u0026plusmn;120.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"94\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"123\"\u003e\n\u003cp\u003e-0.01\u0026plusmn;0.485\u003c/p\u003e\n\u003cp\u003e-0.13\u0026plusmn;0.331\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"95\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable1. Characteristics of the table.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003c/strong\u003e Retro: Retrospective study; Sham/IVA: The patients were treated with IVA after sham treatment; IVR or IVB: Treatment with IVB or IVR; PDT with IVR or IVB: PDT was used in combination with IVB or IVR.\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003eLT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e-0.03 (-0.36, 0.26)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003ePDT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e0.15 (-0.28, 0.60)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e0.17 (-0.14, 0.57)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003eIVA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e0.15 (-0.16, 0.47)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e0.18 (0.02, 0.40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e-0.00 (-0.33, 0.33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e0.16(-0.18, 0.49)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e0.18 (0.01, 0.42)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e0.00 (-0.29, 0.30)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e0.00 (-0.15, 0.17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e-0.05 (-0.57, 0.49)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e-0.02 (-0.44, 0.49)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"87\"\u003e\n\u003cp\u003e-0.19 (-0.48, 0.10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"88\"\u003e\n\u003cp\u003e-0.19 (-0.64, 0.24)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e-0.20 (-0.62, 0.21)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"115\"\u003e\n\u003cp\u003esham/IVA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e \u003cstrong\u003eDifferent treatment methods improve the results of a meta-analysis of BCVA mesh (RCT).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003e\u003cstrong\u003eName\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e\u003cstrong\u003eDirect Effect\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"119\"\u003e\n\u003cp\u003e\u003cstrong\u003eIndirect Effect\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-Value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003ePDT, IVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e-0.10(-0.32,0.13)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"119\"\u003e\n\u003cp\u003e-0.33(-0.57, -0.09)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e-0.18(-0.42, -0.01)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003ePDT, IVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e-0.28(-0.48, -0.09)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"119\"\u003e\n\u003cp\u003e-0.05 (-0.31, 0.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e-0.18(-0.40, -0.02)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e0.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003eIVB, IVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e-0.05 (-0.20, 0.10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"119\"\u003e\n\u003cp\u003e0.19 (-0.12, 0.49)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e-0.00 (-0.17, 0.15)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e. \u003cstrong\u003eThe consistency of direct comparison and indirect comparison of various treatment methods with BCVA change as the node (RCT).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u003cstrong\u003eRank 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u003cstrong\u003eRank 2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u003cstrong\u003eRank 3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u003cstrong\u003eRank 4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u003cstrong\u003eRank 5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u003cstrong\u003eRank 6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003eLT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003ePDT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.43\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003eIVA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.36\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003eSham/IVA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e \u003cstrong\u003eEffect ranking diagram of different treatment methods to improve BCVA (RCT).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote: \u003c/strong\u003eRank1-6 corresponds to the color from light to dark in the ranking diagram; The higher the value, in the Rank6 on behalf of the treatment the better the results.\u003c/p\u003e\n\u003ctable width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"137\"\u003e\n\u003cp\u003e\u003cstrong\u003eIVA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"137\"\u003e\n\u003cp\u003e12.8 (-56.7, 84.2）\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e\u003cstrong\u003eIVB\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"137\"\u003e\n\u003cp\u003e10.9 (-52.1, 73.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e10.9 (-52.1, 73.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u003cstrong\u003eIVR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"137\"\u003e\n\u003cp\u003e52.0(-35.9, 141.8)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"136\"\u003e\n\u003cp\u003e39.0 (-15.1, 93.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e40.8 (-20.9, 105.7)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u003cstrong\u003ePDT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u003c/strong\u003e \u003cstrong\u003eDifferent treatment methods improve the results of a meta-analysis of FCT mesh (RCT).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eRank 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eRank 2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eRank 3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eRank 4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eIVA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003ePDT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.84\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6.\u003c/strong\u003e \u003cstrong\u003eEffect ranking diagram of different treatment methods to improve FCT (RCT).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote: \u003c/strong\u003eRank1-4 corresponds to the color from dark to light in the ranking diagram; The higher the value, in the Rank1 on behalf of the treatment the better the results.\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eIVA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e-0.12 (-0.68, 0.43)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e\u003cstrong\u003eIVB\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e-0.17 (-0.87, 0.52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e-0.05 (-0.54, 0.43)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003eIVB or IVR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.00 (-0.63, 0.65)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e0.13 (-0.36, 0.64)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.16 (-0.47, 0.85)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u003cstrong\u003eIVC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e-0.09 (-0.56, 0.40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e0.03 (-0.23, 0.30)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.07 (-0.40, 0.61)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e-0.10 (-0.51, 0.32)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003eIVR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e-0.34 (-0.92, 0.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e-0.22 (-0.50, 0.03)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-0.18 (-0.58, 0.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e-0.34 (-0.89, 0.14)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e-0.25 (-0.57, 0.02)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e\u003cstrong\u003ePDT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e-0.31 (-1.03, 0.38)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"81\"\u003e\n\u003cp\u003e-0.19 (-0.70, 0.30)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e-0.15 (-0.56, 0.28)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e-0.32 (-1.01, 0.33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e-0.22 (-0.77, 0.28)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"79\"\u003e\n\u003cp\u003e0.04 (-0.40, 0.46)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"86\"\u003e\n\u003cp\u003e\u003cstrong\u003ePDT with IVB or IVR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7.\u003c/strong\u003e \u003cstrong\u003eDifferent treatment methods improve the results of a meta-analysis of BCVA mesh (Retrospective studies).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e\u003cstrong\u003eDirect Effect\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"119\"\u003e\n\u003cp\u003e\u003cstrong\u003eIndirect Effect\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u003cstrong\u003eP-Value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003eIVB, IVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e-0.12 (-0.42, 0.17)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"119\"\u003e\n\u003cp\u003e0.20 (-0.29, 0.69)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e-0.03 (-0.30, 0.23)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e0.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003eIVB, PDT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e0.32 (0.02, 0.62)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"119\"\u003e\n\u003cp\u003e0.00 (-0.47, 0.49)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e0.22 (-0.03, 0.50)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"97\"\u003e\n\u003cp\u003eIVR, PDT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"120\"\u003e\n\u003cp\u003e0.12 (-0.28, 0.52)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"119\"\u003e\n\u003cp\u003e0.44 (0.02, 0.89)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"126\"\u003e\n\u003cp\u003e0.25 (-0.02, 0.57)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8.\u003c/strong\u003e \u003cstrong\u003eThe consistency of direct comparison and indirect comparison of various treatment methods with BCVA change as the node (Retrospective studies).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003eRank 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e\u003cstrong\u003eRank 2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003eRank 3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e\u003cstrong\u003eRank 4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eRank 5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e\u003cstrong\u003eRank 6\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u003cstrong\u003eRank7\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eIVA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e0.39\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e0.30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eIVB/IVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eIVC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e0.36\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e0.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003ePDT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e0.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"142\"\u003e\n\u003cp\u003ePDT with IVB/IVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"76\"\u003e\n\u003cp\u003e0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"70\"\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"75\"\u003e\n\u003cp\u003e0.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9.\u003c/strong\u003e \u003cstrong\u003eEffect ranking diagram of different treatment methods to improve BCVA (Retrospective studies).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote: \u003c/strong\u003eRank1-7 corresponds to the color from light to dark in the ranking diagram; The higher the value, in the Rank7 on behalf of the treatment the better the results.\u003c/p\u003e\n\u003ctable width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eIVA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e87.53 (-50.44, 236.33)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eIVB\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e57.26 (-66.20, 174.77)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e-31.11 (-160.84, 94.04)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eIVC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e47.49 (-51.45, 145.05)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e-40.26 (-146.93, 63.59)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e-9.06 (-76.84, 60.22)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eIVR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e75.91 (-43.26, 195.48)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e-12.96 (-93.66, 62.15)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e18.37 (-78.26, 117.16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e26.75 (-41.75, 95.99)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"118\"\u003e\n\u003cp\u003e\u003cstrong\u003ePDT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 10.\u003c/strong\u003e \u003cstrong\u003eDifferent treatment methods improve the results of a meta-analysis of FCT mesh (Retrospective studies).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eRank 1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eRank 2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eRank 3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eRank 4\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e\u003cstrong\u003eRank 5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eIVA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.04\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eIVB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.06\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.53\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eIVC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003eIVR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.07\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd\u003e\n\u003cp\u003ePDT\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd\u003e\n\u003cp\u003e0.22\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 11.\u003c/strong\u003e \u003cstrong\u003eEffect ranking diagram of different treatment methods to improve FCT (Retrospective studies).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNote: \u003c/strong\u003eRank1-5 corresponds to the color from dark to light in the ranking diagram; The higher the value, in the Rank1 on behalf of the treatment the better the results.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"aflibercept, bevacizumab, conbercept, laser treatment, myopic choroidal neovascularization, network meta-analysis ranibizumab, photodynamic therapy","lastPublishedDoi":"10.21203/rs.3.rs-1988277/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1988277/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e In order to evaluate the efficacy of intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs, photodynamic therapy (PDT), and laser treatment (LT) for anatomical and functional improvement in myopic choroidal neovascularization (mCNV) patients were evaluated in a mesh meta-analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Two researchers independently searched PubMed, Cochrane Library, Web of Science, CNKI, WanFang Data, Embase, and other databases to screen RCTs and retrospective studies comparing best-corrected visual acuity (BCVA) and foveal center thickness (FCT) changes after mCNV treatment. The retrieval time limit is from the database construction to November 30, 2021. ADDIS1.16.8 and R 3.5.3 software were used to conduct mesh meta-analyses of RCTs and retrospective studies, respectively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 601 eyes in 8 RCTs involving 6 treatment options: intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR), intravitreal conbercept (IVC), intravitreal aflibercept (IVA), LT, PDT, sham first followed by IVA (Sham /IVA). The results of the mesh meta-analysis showed that: in the RCTs, IVB and IVR were superior to PDT [MD=0.18, 95%CI (0.01, 0.42)] in improving BCVA of mCNV patients, and all the therapeutic effects from high to low might be intravitreal IVA, IVB, IVR, LT, Sham/IVA, and PDT; the order of FCT thickness reduction from high to low is IVA, IVR, IVB, PDT. In addition, the results of BCVA after long-term treatment in retrospective studies showed that all the therapeutic effects from high to low might be IVA, IVC, IVB /IVR, IVB, IVR, PDT, PDT with IVB /IVR; as for the order of FCT thickness reduction from high to low is IVA, IVC, IVR, IVB, PDT.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Anti-VEGF treatment in patients with long-term improvement in mCNV vision effect is best, using IVB or IVR alone to treat mCNV may be better than IVB or IVR combined with PDT; There was no significant difference in the improvement of visual acuity and macular edema in mCNV patients with different anti-VEGF drugs. Due to the limited number and quality of included literature, the above conclusions need to be confirmed by more large-sample and high-quality articles.\u003c/p\u003e","manuscriptTitle":"Different approaches for the treatment of myopic choroidal neovascular: a network meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-16 21:18:09","doi":"10.21203/rs.3.rs-1988277/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"446ae82f-7a51-47f1-abf7-c9e63ee9719d","owner":[],"postedDate":"September 16th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-11-17T11:44:15+00:00","versionOfRecord":[],"versionCreatedAt":"2022-09-16 21:18:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1988277","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1988277","identity":"rs-1988277","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}