Surgical implantation of steroids with antiangiogenic characteristics for treating neovascular age‐related macular degeneration

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Analysis 1.1

Comparison 1 Triamcinolone acetonide versus placebo, Outcome 1 Visual acuity.

Analysis 2.1

Comparison 2 Anecortave acetate versus control, Outcome 1 Visual acuity ‐ loss of 3 or more lines at 12 months.

Analysis 2.2

Comparison 2 Anecortave acetate versus control, Outcome 2 Visual acuity ‐ loss of 6 or more lines at 12 months.

Table 1. Antiangiogenic agents investigated for potential benefit in exudative AMD

Agent	Putative mechanism
VEGF antagonists i.e. Rhu‐fab	Binds and neutralizes/inactivates VEGF
Dexamethasone	Down‐regulates VEGF expression
Triamcinolone acetonide	Effects vascular endothelial cell matrix turnover and down‐regulates inflammation
Anecortave acetate	Suppression of Plasminogen Activator
Interferon‐alpha	Blocks angiogenic basic fibroblast growth factor and endothelial cell functions
Thalidomide	Inhibits cell migration
Growth hormone antagonists	Inhibits endothelial cell proliferation and VEGF release

Table 1. Antiangiogenic agents investigated for potential benefit in exudative AMD

Comparison 1. Triamcinolone acetonide versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Visual acuity Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 Loss of 3 or more lines vision at 12 months	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 Loss of 6 or more lines vision at 12 months	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 1. Triamcinolone acetonide versus placebo

Comparison 2. Anecortave acetate versus control

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Visual acuity ‐ loss of 3 or more lines at 12 months Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 3 mg Anecortave acetate versus placebo	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.2 15 mg Anecortave acetate versus placebo	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.3 30 mg Anecortave acetate versus placebo	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
1.4 Anecortave acetate with PDT	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 Visual acuity ‐ loss of 6 or more lines at 12 months Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2.1 3 mg Anecortave acetate versus placebo	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.2 15 mg Anecortave acetate versus placebo	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2.3 30 mg Anecortave acetate versus placebo	1		Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. Anecortave acetate versus control