The efficacy of intravitreal anti-VEGF for radiation maculopathy: a systematic review and meta-analysis

Background: Anti-vascular endothelial growth factor (VEGF) therapy is the primary approach for managing radiation maculopathy. However, a noticeable gap exists in meta-analyses evaluating the efficacy of anti-VEGF therapy specifically in the context of radiation maculopathy. Methods: We conducted a review of comparative studies on anti-VEGF treatment up to October 2023. References were sourced from PubMed, EMBASE, and the Cochrane Library. The Cochrane Risk of Bias tool assessed the quality of randomized controlled trials (RCTs), while the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool evaluated non-RCTs. Results: Thirteen articles originating from eleven trials involving 2,525 eyes of 2408 patients were included. Four trials with 2226 eyes examined the effect of preventive anti-VEGF. Four trials with 189 eyes assessed the effect of anti-VEGF for preexisting maculopathy, and three trials with 110 eyes compared different anti-VEGF treatment modalities. In the preventive anti-VEGF treatment meta-analysis over a 24-month follow-up, the anti-VEGF group exhibited significantly fewer cases of radiation maculopathy (OR: 0.40; 95% CI: 0.25, 0.66, P= .0003, I 2 =45%). For the meta-analysis of anti-VEGF treatment for pre-existing radiation maculopathy over a 6-month follow-up, the anti-VEGF group showed improved visual acuity (SMD: −1.13, 95% CI: −1.69 to −0.56, P < .0000, I 2 = 47%) and decreased central macular thickness (SMD: -0.59, 95% CI: −1.13 to −0.05, P = 0.03, I 2 = 62%). Conclusion: Prophylactic anti-VEGF effectively prevents radiation maculopathy and is also beneficial in treating pre-existing radiation maculopathy. Intensive treatment initially provides early benefits, but the efficacy diminishes after transitioning to a treat-and-extend regimen.