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

ABSTRACT

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

KEYWORDS:

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

Acknowledgments

We thank Dr Elizabeth Thorne, Dr Matthew Schlenker, and Maxim Zaslavsky PhD(c) for helpful feedback on this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

K.Z., L.D.D, M.M. conceived the project. K.Z. performed the primary review. T.P. and R.L.M. performed the secondary review. M.M. and L.D.D. provided data for the case report. K.Z. performed an analysis of IPD data. K.Z. wrote the manuscript. The manuscript was jointly edited by all authors. L.D.D and M.M. supervised the project.

Data and code availability

The aggregate IPD dataset, as well as R code used to analyze the data and produce corresponding plots, is provided as a supplementary file and on GitHub (https://github.com/kzaslavsky/PIC_PRISMA-IPD).

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.