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Intervenciones para la coriorretinopatía serosa central: un metanálisis en red

Appendices

Appendix 1. CENTRAL search strategy

#1 MeSH descriptor: [Central Serous Chorioretinopathy] explode all trees
#2 central serous near/2 (retinopath* or chorioretinopath*)
#3 retinitis near/3 (angiospastic* or serosa or capillarospastic or capillarospastic or angiosplastic)
#4 retinopath* near/3 (angiospastic* or serosa or capillarospastic or capillarospastic or angiosplastic)
#5 central* near/3 (retinitis or serosa)
#6 #1 or #2 or #3 or #4 or #5

Appendix 2. MEDLINE (Ovid) search strategy

1. randomized controlled trial.pt.
2. (randomized or randomised).ab,ti.
3. placebo.ab,ti.
4. dt.fs.
5. randomly.ab,ti.
6. trial.ab,ti.
7. groups.ab,ti.
8. or/1‐7
9. exp animals/
10. exp humans/
11. 9 not (9 and 10)
12. 8 not 11
13. Central Serous Chorioretinopathy/
14. (central serous adj2 (retinopath$ or chorioretinopath$)).tw.
15. (retinitis adj3 (angiospastic$ or serosa or capillarospastic or capillarospastic or angiosplastic)).tw.
16. (retinopath$ adj3 (angiospastic$ or serosa or capillarospastic or capillarospastic or angiosplastic)).tw.
17. (central$ adj3 (retinitis or serosa)).tw.
18. or/13‐17
19. 12 and 18

The search filter for trials at the beginning of the MEDLINE strategy is from the published paper by Glanville et al (Glanville 2006).

Appendix 3. EMBASE (Ovid) search strategy

1. exp randomized controlled trial/
2. exp randomization/
3. exp double blind procedure/
4. exp single blind procedure/
5. random$.tw.
6. or/1‐5
7. (animal or animal experiment).sh.
8. human.sh.
9. 7 and 8
10. 7 not 9
11. 6 not 10
12. exp clinical trial/
13. (clin$ adj3 trial$).tw.
14. ((singl$ or doubl$ or trebl$ or tripl$) adj3 (blind$ or mask$)).tw.
15. exp placebo/
16. placebo$.tw.
17. random$.tw.
18. exp experimental design/
19. exp crossover procedure/
20. exp control group/
21. exp latin square design/
22. or/12‐21
23. 22 not 10
24. 23 not 11
25. exp comparative study/
26. exp evaluation/
27. exp prospective study/
28. (control$ or prospectiv$ or volunteer$).tw.
29. or/25‐28
30. 29 not 10
31. 30 not (11 or 23)
32. 11 or 24 or 31
33. central serous retinopathy/
34. (central serous adj2 (retinopath$ or chorioretinopath$)).tw.
35. (retinitis adj3 (angiospastic$ or serosa or capillarospastic or capillarospastic or angiosplastic)).tw.
36. (retinopath$ adj3 (angiospastic$ or serosa or capillarospastic or capillarospastic or angiosplastic)).tw.
37. (central$ adj3 (retinitis or serosa)).tw.
38. or/33‐37
39. 32 and 38

Appendix 4. ISRCTN search strategy

(central serous retinopathy) OR (central serous chorioretinopathy)

Appendix 5. ClinicalTrials.gov search strategy

central serous retinopathy OR central serous chorioretinopathy

Appendix 6. ICTRP search strategy

"central serous retinopathy"

"central serous chorioretinopathy"

Appendix 7. Data on study characteristics

Mandatory items

Optional items

Methods

Study design

· Parallel group RCTi.e. people randomized to treatment

· Within‐person RCTi.e. eyes randomized to treatment

· Cluster RCTi.e. communities randomized to treatment

· Cross‐over RCTi.e. people randomized to sequence of treatment

· Other, specify

Exclusions after randomization

Losses to follow‐up

Number randomized/analyzed

How were missing data handled? e.g., available case analysis, imputation methods

Reported power calculation (Y/N), if yes, sample size and power

Unusual study design/issues

Unit of randomization/unit of analysis

· One eye included in study, specify how eye selected

· Two eyes included in study, both eyes received same treatment, briefly specify how analyzed(best/worst/average/both and adjusted for within person correlation/both and not adjusted for within person correlation) and specify if mixture one eye and two eye

· Two eyes included in study, eyes received different treatments,specify if correct pair‐matched analysis done

Participants

Country

Setting

Ethnic group

Equivalence of baseline characteristics (Y/N)

Total number of participants

This information should be collected for total study population recruited into the study. If these data are only reported for the people who were followed up only, please indicate.

Number (%) of men and women

Average age and age range

Inclusion criteria

Exclusion criteria

Interventions

Intervention (n= )

Comparator (n= )

· Number of people randomized to this group

· Drug (or intervention) name

· Dose

· Frequency

· Route of administration

Outcomes

Primary and secondary outcomes as defined in study reports

List outcomes

Adverse events reported (Y/N)

Length of follow‐up and intervals at which outcomes assessed

Planned/actual length of follow‐up

Theoretical treatment network.
Figures and Tables -
Figure 1

Theoretical treatment network.

Study flow diagram.
Figures and Tables -
Figure 2

Study flow diagram.

Risk of bias summary: review authors' judgments about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgments about each risk of bias item for each included study.

Visual acuity network: network plot, interval plot, contribution matrix and risk of bias.AVG: Anti‐VEGF PDT: photodynamic therapy LAS: laser AVPDT: anti‐VEGF plus PDT.1 = control; 2 = anti‐VEGF; 3 = PDT; 4 = laser; 5 = anti‐VEGF plus PDT.
Figures and Tables -
Figure 4

Visual acuity network: network plot, interval plot, contribution matrix and risk of bias.

AVG: Anti‐VEGF PDT: photodynamic therapy LAS: laser AVPDT: anti‐VEGF plus PDT.

1 = control; 2 = anti‐VEGF; 3 = PDT; 4 = laser; 5 = anti‐VEGF plus PDT.

Recurrence CSC network: network plot, interval plot, contribution matrix and risk of bias.AVG: Anti‐VEGF; PDT: photodynamic therapy; LAS: laser: CTL: control.1 = control; 2 = anti‐VEGF; 3 = PDT; 4 = laser.
Figures and Tables -
Figure 5

Recurrence CSC network: network plot, interval plot, contribution matrix and risk of bias.

AVG: Anti‐VEGF; PDT: photodynamic therapy; LAS: laser: CTL: control.

1 = control; 2 = anti‐VEGF; 3 = PDT; 4 = laser.

Comparison 1 Anti‐VEGF versus observation, Outcome 1 Mean change in BCVA at 12 months.
Figures and Tables -
Analysis 1.1

Comparison 1 Anti‐VEGF versus observation, Outcome 1 Mean change in BCVA at 12 months.

Comparison 1 Anti‐VEGF versus observation, Outcome 2 Mean change in CRT at 12 months.
Figures and Tables -
Analysis 1.2

Comparison 1 Anti‐VEGF versus observation, Outcome 2 Mean change in CRT at 12 months.

Comparison 2 Anti‐VEGF versus low fluence PDT, Outcome 1 Mean change in BCVA at 12 months.
Figures and Tables -
Analysis 2.1

Comparison 2 Anti‐VEGF versus low fluence PDT, Outcome 1 Mean change in BCVA at 12 months.

Comparison 2 Anti‐VEGF versus low fluence PDT, Outcome 2 Recurrence of CSC at 12 months.
Figures and Tables -
Analysis 2.2

Comparison 2 Anti‐VEGF versus low fluence PDT, Outcome 2 Recurrence of CSC at 12 months.

Comparison 2 Anti‐VEGF versus low fluence PDT, Outcome 3 Persistent CSC at 12 months.
Figures and Tables -
Analysis 2.3

Comparison 2 Anti‐VEGF versus low fluence PDT, Outcome 3 Persistent CSC at 12 months.

Comparison 2 Anti‐VEGF versus low fluence PDT, Outcome 4 Mean change in CRT at 12 months.
Figures and Tables -
Analysis 2.4

Comparison 2 Anti‐VEGF versus low fluence PDT, Outcome 4 Mean change in CRT at 12 months.

Comparison 3 Anti‐VEGF plus 50% PDT versus 50% PDT, Outcome 1 Mean change in BCVA at 12 months.
Figures and Tables -
Analysis 3.1

Comparison 3 Anti‐VEGF plus 50% PDT versus 50% PDT, Outcome 1 Mean change in BCVA at 12 months.

Comparison 3 Anti‐VEGF plus 50% PDT versus 50% PDT, Outcome 2 Persistent CSC at 12 months.
Figures and Tables -
Analysis 3.2

Comparison 3 Anti‐VEGF plus 50% PDT versus 50% PDT, Outcome 2 Persistent CSC at 12 months.

Comparison 3 Anti‐VEGF plus 50% PDT versus 50% PDT, Outcome 3 Mean change in CRT at 12 months.
Figures and Tables -
Analysis 3.3

Comparison 3 Anti‐VEGF plus 50% PDT versus 50% PDT, Outcome 3 Mean change in CRT at 12 months.

Comparison 4 Six‐dose anti‐VEGF versus four‐dose anti‐VEGF, Outcome 1 Mean change in BCVA at 12 months.
Figures and Tables -
Analysis 4.1

Comparison 4 Six‐dose anti‐VEGF versus four‐dose anti‐VEGF, Outcome 1 Mean change in BCVA at 12 months.

Comparison 4 Six‐dose anti‐VEGF versus four‐dose anti‐VEGF, Outcome 2 Mean change in CRT at 12 months.
Figures and Tables -
Analysis 4.2

Comparison 4 Six‐dose anti‐VEGF versus four‐dose anti‐VEGF, Outcome 2 Mean change in CRT at 12 months.

Comparison 5 50% PDT versus sham treatment, Outcome 1 Mean BCVA at 12 months.
Figures and Tables -
Analysis 5.1

Comparison 5 50% PDT versus sham treatment, Outcome 1 Mean BCVA at 12 months.

Comparison 5 50% PDT versus sham treatment, Outcome 2 Recurrence/persistence CSC at 12 months.
Figures and Tables -
Analysis 5.2

Comparison 5 50% PDT versus sham treatment, Outcome 2 Recurrence/persistence CSC at 12 months.

Comparison 5 50% PDT versus sham treatment, Outcome 3 Mean CRT at 12 months.
Figures and Tables -
Analysis 5.3

Comparison 5 50% PDT versus sham treatment, Outcome 3 Mean CRT at 12 months.

Comparison 6 30% PDT versus PDT, Outcome 1 Mean BCVA at 12 months.
Figures and Tables -
Analysis 6.1

Comparison 6 30% PDT versus PDT, Outcome 1 Mean BCVA at 12 months.

Comparison 6 30% PDT versus PDT, Outcome 2 Recurrence of CSC at 12 months.
Figures and Tables -
Analysis 6.2

Comparison 6 30% PDT versus PDT, Outcome 2 Recurrence of CSC at 12 months.

Comparison 6 30% PDT versus PDT, Outcome 3 Mean change in CRT at 12 months.
Figures and Tables -
Analysis 6.3

Comparison 6 30% PDT versus PDT, Outcome 3 Mean change in CRT at 12 months.

Comparison 7 50% PDT versus PDT, Outcome 1 Mean BCVA at 12 months.
Figures and Tables -
Analysis 7.1

Comparison 7 50% PDT versus PDT, Outcome 1 Mean BCVA at 12 months.

Comparison 7 50% PDT versus PDT, Outcome 2 Recurrence of CSC at 12 months.
Figures and Tables -
Analysis 7.2

Comparison 7 50% PDT versus PDT, Outcome 2 Recurrence of CSC at 12 months.

Comparison 7 50% PDT versus PDT, Outcome 3 Mean change in CRT at 12 months.
Figures and Tables -
Analysis 7.3

Comparison 7 50% PDT versus PDT, Outcome 3 Mean change in CRT at 12 months.

Comparison 8 30% PDT versus 50% PDT, Outcome 1 Mean change in BCVA at 12 months.
Figures and Tables -
Analysis 8.1

Comparison 8 30% PDT versus 50% PDT, Outcome 1 Mean change in BCVA at 12 months.

Comparison 8 30% PDT versus 50% PDT, Outcome 2 Recurrence of CSC at 12 months.
Figures and Tables -
Analysis 8.2

Comparison 8 30% PDT versus 50% PDT, Outcome 2 Recurrence of CSC at 12 months.

Comparison 8 30% PDT versus 50% PDT, Outcome 3 Persistent CSC at 12 months.
Figures and Tables -
Analysis 8.3

Comparison 8 30% PDT versus 50% PDT, Outcome 3 Persistent CSC at 12 months.

Comparison 8 30% PDT versus 50% PDT, Outcome 4 Mean change in CRT at 12 months.
Figures and Tables -
Analysis 8.4

Comparison 8 30% PDT versus 50% PDT, Outcome 4 Mean change in CRT at 12 months.

Comparison 9 Laser versus observation or sham treatment, Outcome 1 Mean change in BCVA at 12 months.
Figures and Tables -
Analysis 9.1

Comparison 9 Laser versus observation or sham treatment, Outcome 1 Mean change in BCVA at 12 months.

Comparison 9 Laser versus observation or sham treatment, Outcome 2 Recurrence of CSC at 12 months.
Figures and Tables -
Analysis 9.2

Comparison 9 Laser versus observation or sham treatment, Outcome 2 Recurrence of CSC at 12 months.

Comparison 9 Laser versus observation or sham treatment, Outcome 3 Mean change in CRT at 12 months.
Figures and Tables -
Analysis 9.3

Comparison 9 Laser versus observation or sham treatment, Outcome 3 Mean change in CRT at 12 months.

Comparison 10 Indirect argon laser versus direct argon laser, Outcome 1 Recurrence of CSC at 12 months.
Figures and Tables -
Analysis 10.1

Comparison 10 Indirect argon laser versus direct argon laser, Outcome 1 Recurrence of CSC at 12 months.

Comparison 11 Comparison of different laser wavelengths, Outcome 1 Recurrence of CSC at 12 months.
Figures and Tables -
Analysis 11.1

Comparison 11 Comparison of different laser wavelengths, Outcome 1 Recurrence of CSC at 12 months.

Comparison 12 Antioxidant supplements versus placebo, Outcome 1 BCVA at 12 months.
Figures and Tables -
Analysis 12.1

Comparison 12 Antioxidant supplements versus placebo, Outcome 1 BCVA at 12 months.

Comparison 12 Antioxidant supplements versus placebo, Outcome 2 Recurrence at 12 months.
Figures and Tables -
Analysis 12.2

Comparison 12 Antioxidant supplements versus placebo, Outcome 2 Recurrence at 12 months.

Comparison 12 Antioxidant supplements versus placebo, Outcome 3 Persistence at 12 months.
Figures and Tables -
Analysis 12.3

Comparison 12 Antioxidant supplements versus placebo, Outcome 3 Persistence at 12 months.

Comparison 12 Antioxidant supplements versus placebo, Outcome 4 CRT at 12 months.
Figures and Tables -
Analysis 12.4

Comparison 12 Antioxidant supplements versus placebo, Outcome 4 CRT at 12 months.

Comparison 13 Beta‐blocker versus placebo, Outcome 1 Mean BCVA at 12 months.
Figures and Tables -
Analysis 13.1

Comparison 13 Beta‐blocker versus placebo, Outcome 1 Mean BCVA at 12 months.

Comparison 13 Beta‐blocker versus placebo, Outcome 2 Recurrence of CSC at 12 months.
Figures and Tables -
Analysis 13.2

Comparison 13 Beta‐blocker versus placebo, Outcome 2 Recurrence of CSC at 12 months.

Comparison 13 Beta‐blocker versus placebo, Outcome 3 BCVA ≥ 20/40 at 12 months.
Figures and Tables -
Analysis 13.3

Comparison 13 Beta‐blocker versus placebo, Outcome 3 BCVA ≥ 20/40 at 12 months.

Comparison 14 Carbonic anhydrase inhibitors versus placebo, Outcome 1 Recurrent/persistent CSC at 12 months.
Figures and Tables -
Analysis 14.1

Comparison 14 Carbonic anhydrase inhibitors versus placebo, Outcome 1 Recurrent/persistent CSC at 12 months.

Comparison 15 Helicobacter pylori treatment versus placebo or observation, Outcome 1 Mean BCVA at 12 months.
Figures and Tables -
Analysis 15.1

Comparison 15 Helicobacter pylori treatment versus placebo or observation, Outcome 1 Mean BCVA at 12 months.

Comparison 15 Helicobacter pylori treatment versus placebo or observation, Outcome 2 Persistent CSC at 12 months.
Figures and Tables -
Analysis 15.2

Comparison 15 Helicobacter pylori treatment versus placebo or observation, Outcome 2 Persistent CSC at 12 months.

Summary of findings for the main comparison. Interventions for central serous chorioretinopathy: direct comparisons

Interventions for central serous chorioretinopathy: direct comparisons

Patient or population: people with central serous chorioretinopathy

Settings: eye hospital

Comparison

(intervention vs. comparator)

Anticipated absolute effects (95% CI)

Effect estimate from direct comparison

Comments

Relative effect
(95% CI)

No of participants
(studies)

Quality

Risk with comparator

Mean difference (95% CI) Negative values are in favor of intervention; positive values in favor of comparator

Change in visual acuity at 12 months (logMAR)

Anti‐VEGF vs. observation

0.01 LogMAR (‐0.02 to 0.03)

64 (2)

Low1,2

Both studies enrolled participants with acute CSC and reported mean change in visual acuity at 6 months

Anti‐VEGF vs. low‐fluence PDT

0.03 logMAR (‐0.08 to 0.15)

56 (2)

Low1,2

Both studies enrolled participants with chronic CSC

Anti‐VEGF and 50% PDT vs. 50% PDT

0.30 logMAR (0.09 to 0.51)

15 (1)

Low1,2

Participants had chronic CSC

6‐dose anti‐VEGF vs. 4‐dose anti‐VEGF

‐0.02 logMAR (‐0.31 to 0.27)

12 (1)

Low1,2

Participants had chronic CSC and were followed to 6 months

50% PDT vs. observation or sham treatment

‐0.10 logMAR (‐0.18 to ‐0.02)

58 (1)

Low1,2

Participants had acute CSC

30% PDT vs. PDT

‐0.16 logMAR (‐0.22 to ‐0.10)

60 (1)

Low1,2

Type of CSC not specified

30% PDT vs. 50% PDT

‐0.12 logMAR (‐0.15 to ‐0.08)

60 (1)

Low1,2

Type of CSC not specified

50% PDT vs. PDT

0.04 logMAR (‐0.04 to 0.12

60 (1)

Low1,2

Type of CSC not specified

Selective retina therapy vs. observation

‐0.13 logMAR (‐0.24 to ‐0.01)

30 (1)

Low1,2

Participants had acute CSC, followed up to 3 months

Micropulse diode laser vs. sham laser

‐0.38 logMAR (‐0.56 to ‐0.20)

15 (1)

Low1,2

Participants had chronic CSC

Antioxidant vs. placebo

0.01 logMAR (‐0.04 to 0.06)

14 (1)

Low1,2

Lutein and acute CSC

Propranolol vs. placebo

0.01 logMAR (‐0.07 to 0.09)

60 (1)

Low1,2

Type of CSC not specified

Carbonic anhydrase inhibitors vs. placebo

See comment

13 (1)

Outcome not reported

Helicobacter pylori treatment vs. placebo

‐0.04 logMAR (‐0.07 to ‐0.02)

103 (2)

Low1,2

Participants had acute CSC, follow‐up 12‐16 weeks

Comparison

(intervention vs. comparator)

Anticipated absolute effects (95% CI)

Effect estimate from direct comparison

Comments

Risk with comparator*

Risk with intervention

Relative effect (95% CI)

No of participants
(studies)

Quality

Persistent CSC at 12 months

Anti‐VEGF vs. observation

See comment

64 (2)

Participants had acute CSC. Both trials reported that all participants in treatment and control groups were resolved by 6 months

Anti‐VEGF vs. low‐fluence PDT

111 per 1000

688 per 1000 (179 to 1000)

RR 6.19 (1.61 to 23.81)

34 (1)

Low1,2

Participants had chronic CSC

Anti‐VEGF and 50% PDT vs. 50% PDT

143 per 1000

126 (10 to 1000)

RR 0.88 (0.07 to 11.54)

15 (1)

Very low1,2,3

Participants had chronic CSC

6‐dose anti‐VEGF vs. 4‐dose anti‐VEGF

See comment

12 (1)

Outcome not reported

50% PDT vs. sham treatment

211 per 1000

25 per 1000 (2 to 215)

RR 0.12 (0.01 to 1.02)

58 (1)

Low1,2

Participants had acute CSC

30% PDT vs. PDT

See comment

60 (1)

Outcome not reported

30% PDT vs. 50% PDT

See comment

60 (1)

Outcome not reported

50% PDT vs. PDT

See comment

60 (1)

Outcome not reported

Selective retina therapy vs. observation

See comment

30 (1)

Outcome not reported

Micropulse diode laser

See comment

15 (1)

Outcome not reported

Antioxidant vs. placebo

See comment

51 (1)

People in the antioxidant group were less likely to have "complete resolution" at 3 months (RR 0.35, 95% CI 0.13 to 0.95; 51 participants)

Propranolol vs. placebo

See comment

60 (1)

Outcome not reported

Brinzolamide vs. placebo

167 per 1000

48 (2 to 1000)

RR 0.29 (0.01 to 6.07)

13 (1)

Very low2,3

Participants had acute CSC

Helicobacter pylori treatment vs. placebo

314 per 1000

210 (113 to 383)

RR 0.67 (0.36 to 1.22)

103 (2)

Low1,2

Participants had acute CSC

Comparison

(intervention vs. comparator)

Anticipated absolute effects (95% CI)

Effect estimate from direct comparison

Risk with comparator*

Risk with intervention

Relative effect (95% CI)

No of participants
(studies)

Quality

Comment

Recurrent CSC at 12 months

Anti‐VEGF vs. observation

See comment

64 (2)

Outcome not reported

Anti‐VEGF vs. low‐fluence PDT

See comment

56 (2)

Very low1,2,4

Participants had chronic CSC. The 2 studies had different results for this outcome (I2 = 71%). In Bae 2011, there was a much higher risk of recurrence in the anti‐VEGF group (ranibizumab) compared with the PDT group (RR 19.83, 95% CI 1.19 to 330.50; 21 eyes); in Semeraro 2012, there was also an increased risk of recurrence in the anti‐VEGF (bevacizumab) group but the size of the effect was much smaller and the CIs include 1 (no effect) (RR 1.46, 95% CI 0.59 to 3.58; 22 eyes)

Anti‐VEGF and 50% PDT vs. 50% PDT

See comment

15 (1)

Outcome not reported

6‐dose anti‐VEGF vs. 4‐dose anti‐VEGF

See comment

12 (1)

Outcome not reported

50% PDT vs. sham treatment

267 per 1000

27 per 1000 (3 to 216)

RR 0.10 (0.01 to 0.81)

53 (1)

Low1,2

Participants had acute CSC

30% PDT vs. PDT

See comment

60 (1)

Outcome not reported

30% PDT vs. 50% PDT

See comment

60 (1)

Outcome not reported

50% PDT vs. PDT

270 per 1000

338 per 1000 (154 to 737)

RR 1.25 (0.57 to 2.73)

60 (1)

Type of CSC not specified

Selective retina therapy vs. observation

See comment

30 (1)

Outcome not reported

Micropulse diode laser

See comment

15 (1)

Outcome not reported

Antioxidant vs. placebo

143 per 1000

46 (4 to 456)

RR 0.32 (0.03 to 3.19)

36 (1)

Very low2,3

Participants had acute CSC

Propranolol vs. placebo

167 per 1000

100 (27 to 382)

RR 0.60 (0.16 to 2.29)

60 (1)

Low1,2

Type of CSC not reported

Brinzolamide vs. placebo

314 per 1000

140 (20 to 953)

RR 0.21 (0.03 to 1.43

13 (1)

Low1,2

Participants had acute CSC

Helicobacter pylori treatment vs. placebo

See comment

103 (2)

Outcome not reported

Adverse effects

All studies reported no ocular or systematic adverse effects, or did not comment on adverse effects

anti‐VEGF: anti‐vascular endothelial growth factor; CI: confidence interval; CSC: central serous chorioretinopathy; logMAR: logarithm of the minimal angle of resolution; PDT: photodynamic therapy; RR: risk ratio.

* Risk was estimated from the comparator group in the included studies

1 Downgraded for imprecision (‐1)

2 Downgraded for risk of bias (‐1)

3 Downgraded for imprecision (‐2)

4 Downgraded for inconsistency (‐1)

Figures and Tables -
Summary of findings for the main comparison. Interventions for central serous chorioretinopathy: direct comparisons
Table 1. Assessment of transitivity across treatment comparisons: visual acuity

Treatment comparison

Study

Type of CSC

Date study conducted

Industry sponsored

Anti‐VEGF vs. PDT

Bae 2011

Semeraro 2012

Chronic

Chronic

2009‐2012

2009‐2010

Yes

NR

PDT vs. no treatment

Chan 2008

Acute

2004‐2005

NR

Laser vs. no treatment

Robertson 1983

Acute

1977‐1981

No

One additional study for the comparison PDT vs. no treatment was reported in abstract form only and no data on outcome so was not included in the network meta‐analysis (Boscia 2008).

anti‐VEGF: anti‐vascular endothelial growth factor; CSC: central serous chorioretinopathy; NR: not reported; PDT: photodynamic therapy.

Figures and Tables -
Table 1. Assessment of transitivity across treatment comparisons: visual acuity
Table 2. Comparative effects of ocular interventions for central serous chorioretinopathy: visual acuity

Anti‐VEGF

‐0.08 (‐0.14 to ‐0.01)

‐0.20 (‐0.30 to ‐0.11)

0.00 (‐0.02 to 0.03)

0.22 (0.01 to 0.44)

0.08 (0.01 to 0.14)

PDT

‐0.13 (‐0.24 to ‐0.01)

0.08 (0.01 to 0.15)

0.30 (0.09 to 0.51)

0.20 (0.11 to 0.30)

0.13 (0.01 to 0.24)

Laser

0.21 (0.11 to 0.31)

0.43 (0.19 to 0.66)

‐0.00 (‐0.03 to 0.02)

‐0.08 (‐0.15 to ‐0.01)

‐0.21 (‐0.31 to ‐0.11)

Anti‐VEGF and PDT

0.22 (0.00 to 0.44)

‐0.22 (‐0.44 to ‐0.01)

‐0.30 (‐0.51 to ‐0.09)

‐0.43 (‐0.66 to ‐0.19)

‐0.22 (‐0.44 to ‐0.00)

Control (no treatment or sham treatment)

Effect estimate is the mean difference (95% confidence interval). Negative values favor the first intervention. In the lower left hand triangle, the first intervention is anti‐VEGF, PDT, laser etc. In the upper right hand triangle, the first intervention is control, anti‐VEGF and PDT, laser etc. So, for example, visual acuity with anti‐VEGF was 0.22 logMAR units better than control 95% CI 0.44 better to 0.01 better.

anti‐VEGF: anti‐vascular endothelial growth factor; logMAR: logarithm of the minimal angle of resolution; PDT: photodynamic therapy.

Figures and Tables -
Table 2. Comparative effects of ocular interventions for central serous chorioretinopathy: visual acuity
Table 3. Assessment of transitivity across treatment comparisons: recurrence

Treatment comparison

Study

Type of CSC

Date study conducted

Industry sponsored

Anti‐VEGF vs. no treatment

Kim 2013

Lim 2010

Acute

Acute

2010‐2011

2008

No

No

Anti‐VEGF vs. PDT

Bae 2011

Semeraro 2012

Chronic

Chronic

2009‐2012

2009‐2010

Yes

NR

Anti‐VEGF + PDT vs. PDT alone

Coskun 2014

Chronic

NR (published 2014)

NR

PDT vs. no treatment

Chan 2008

Acute

2004‐2005

NR

Laser vs. no treatment

Klatt 2011

Robertson 1983

Roisman 2013

Acute

Acute

Chronic

2007‐2008

1977‐1981

NR (published 2013)

NR

No

NR

One additional study for the comparison PDT vs no treatment was reported in abstract form only and no data on outcome so was not included in the network meta‐analysis (Boscia 2008).

anti‐VEGF: anti‐vascular endothelial growth factor; CSC: central serous chorioretinopathy; NR: not reported; PDT: photodynamic therapy.

Figures and Tables -
Table 3. Assessment of transitivity across treatment comparisons: recurrence
Table 4. Comparative effects of ocular interventions for CSC: recurrence

Anti‐VEGF

0.27 (0.02 to 3.73)

3.34 (0.01 to 788.57)

2.67 (0.03 to 234.08)

3.77 (0.27 to 52.94)

PDT

12.58 (0.11 to 1503.87)

10.07 (0.27 to 371.91)

0.30 (0.00 to 70.79)

0.08 (0.00 to 9.50)

Laser

0.80 (0.03 to 18.46)

0.37 (0.00 to 32.83)

0.10 (0.00 to 3.67)

1.25 (0.05 to 28.85)

Control

Effect estimate is the risk ratio (95% CI).

anti‐VEGF: anti‐vascular endothelial growth factor; logMAR: logarithm of the minimal angle of resolution; PDT: photodynamic therapy.

Figures and Tables -
Table 4. Comparative effects of ocular interventions for CSC: recurrence
Comparison 1. Anti‐VEGF versus observation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean change in BCVA at 12 months Show forest plot

2

64

Mean Difference (IV, Fixed, 95% CI)

0.01 [‐0.02, 0.03]

2 Mean change in CRT at 12 months Show forest plot

2

64

Mean Difference (IV, Fixed, 95% CI)

8.73 [‐18.08, 35.54]

Figures and Tables -
Comparison 1. Anti‐VEGF versus observation
Comparison 2. Anti‐VEGF versus low fluence PDT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean change in BCVA at 12 months Show forest plot

2

56

Mean Difference (IV, Fixed, 95% CI)

0.03 [‐0.08, 0.15]

2 Recurrence of CSC at 12 months Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Persistent CSC at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4 Mean change in CRT at 12 months Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 2. Anti‐VEGF versus low fluence PDT
Comparison 3. Anti‐VEGF plus 50% PDT versus 50% PDT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean change in BCVA at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Persistent CSC at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Mean change in CRT at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 3. Anti‐VEGF plus 50% PDT versus 50% PDT
Comparison 4. Six‐dose anti‐VEGF versus four‐dose anti‐VEGF

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean change in BCVA at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Mean change in CRT at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 4. Six‐dose anti‐VEGF versus four‐dose anti‐VEGF
Comparison 5. 50% PDT versus sham treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean BCVA at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Recurrence/persistence CSC at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Recurrence of CSC at 12 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 Persistent CSC at 12 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Mean CRT at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 5. 50% PDT versus sham treatment
Comparison 6. 30% PDT versus PDT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean BCVA at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Recurrence of CSC at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Mean change in CRT at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 6. 30% PDT versus PDT
Comparison 7. 50% PDT versus PDT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean BCVA at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Recurrence of CSC at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Mean change in CRT at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 7. 50% PDT versus PDT
Comparison 8. 30% PDT versus 50% PDT

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean change in BCVA at 12 months Show forest plot

2

177

Mean Difference (IV, Fixed, 95% CI)

‐0.12 [‐0.15, ‐0.08]

2 Recurrence of CSC at 12 months Show forest plot

2

153

Risk Ratio (M‐H, Fixed, 95% CI)

2.50 [1.54, 4.06]

3 Persistent CSC at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4 Mean change in CRT at 12 months Show forest plot

2

177

Mean Difference (IV, Fixed, 95% CI)

44.90 [42.57, 47.23]

Figures and Tables -
Comparison 8. 30% PDT versus 50% PDT
Comparison 9. Laser versus observation or sham treatment

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean change in BCVA at 12 months Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Recurrence of CSC at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Mean change in CRT at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 9. Laser versus observation or sham treatment
Comparison 10. Indirect argon laser versus direct argon laser

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Recurrence of CSC at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 10. Indirect argon laser versus direct argon laser
Comparison 11. Comparison of different laser wavelengths

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Recurrence of CSC at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 Yellow compared with red

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Yellow compared with green

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Red compared with green

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 11. Comparison of different laser wavelengths
Comparison 12. Antioxidant supplements versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 BCVA at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Recurrence at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Persistence at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4 CRT at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 12. Antioxidant supplements versus placebo
Comparison 13. Beta‐blocker versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean BCVA at 12 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Recurrence of CSC at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 BCVA ≥ 20/40 at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 13. Beta‐blocker versus placebo
Comparison 14. Carbonic anhydrase inhibitors versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Recurrent/persistent CSC at 12 months Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

1.1 Recurrence of CSC at 12 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Persistent CSC at 12 months

1

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 14. Carbonic anhydrase inhibitors versus placebo
Comparison 15. Helicobacter pylori treatment versus placebo or observation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Mean BCVA at 12 months Show forest plot

2

103

Mean Difference (IV, Fixed, 95% CI)

‐0.04 [‐0.07, ‐0.02]

2 Persistent CSC at 12 months Show forest plot

2

103

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.36, 1.22]

Figures and Tables -
Comparison 15. Helicobacter pylori treatment versus placebo or observation