Twenty six studies (n=1,420) were included in the review: three RCTs and 23 uncontrolled studies. Sample sizes ranged between nine and 156 participants. Follow-up times ranged from four to 48 weeks. Quality scores of the three RCTs ranged between 5 to 8 out of 11, which indicated poor- to reasonable-quality trials. The methodological quality of the remaining studies was middling, with consecutive cases being enrolled in 10 studies, no blinded assessment of primary outcomes and 15 studies that used standardised methods of assessment of outcomes.
Three RCTs (n=248) showed greater effectiveness of bevacizumab compared to photodynamic therapy with and without triamcinolone in improved visual acuity (range of weighted mean changes with bevacizumab on the ETDRS across the trials: 8.6 to 12 letters) and decreased central retinal thickness (range of weighted mean changes with bevacizumab in central retinal thickness across the trials: -55μm to -113μm).
One small RCT (n=52) found benefits of a combined treatment of bevacizumab and photodynamic therapy in improvements in visual acuity (weighted mean change on the ETDRS: 12.3 letters compared to 8.6 letters for bevacizumab and 2.5 letters for photodynamic therapy) and decreased central retinal thickness (weighted mean change: -65μm)
Adverse events reported included mild inflammatory responses, mild vitritis, pigment epithelial ruptures, cataract progression, endophthalmitis and transient corneal epitheliopathy. Eighteen studies reported no adverse ocular or systemic adverse events.