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Cochrane Database of Systematic Reviews

Intervenciones para la coriorretinopatía serosa central: un metanálisis en red

Información

DOI:
https://doi.org/10.1002/14651858.CD011841.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 22 diciembre 2015see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Salud ocular y de la visión

Copyright:
  1. Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Mahsa Salehi

    Correspondencia a: Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA

    [email protected]

  • Adam S Wenick

    Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA

  • Hua Andrew Law

    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA

  • Jennifer R Evans

    Cochrane Eyes and Vision, ICEH, London School of Hygiene & Tropical Medicine, London, UK

  • Peter Gehlbach

    Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA

Contributions of authors

Each author has undertaken all of the following tasks listed:

  • conceived or designed the study, or both;

  • drafted the review or commented on it critically for intellectual content;

  • provided final approval of the document to be published.

MS, AL, and JE performed study screening and data extraction.

Sources of support

Internal sources

  • National Institute of Health Research (NIHR), UK.

    This review was funded through the NIHR Cochrane Incentive Scheme and partly funded Jennifer Evan's salary.

External sources

  • Cochrane Eyes and Vision US Project, supported by cooperative agreement 1 U01 EY020522, National Eye Institute, National Institutes of Health, Department of Health and Human Services, USA.

  • National Institute for Health Research (NIHR), UK.

    • Richard Wormald, Co‐ordinating Editor for Cochrane Eyes and Vision (CEV) acknowledges financial support for his CEV research sessions from the Department of Health through the award made by the National Institute for Health Research to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Specialist Biomedical Research Centre for Ophthalmology.

    • The NIHR also funds the CEV Editorial Base in London.

    The views expressed in this publication are those of the authors and not necessarily those of the NIHR, NHS, or the Department of Health.

Declarations of interest

None known.

Acknowledgements

We thank Iris Gordon, Trials Search Co‐ordinator for Cochrane Eyes and Vision, for creating and executing the electronic search strategies. We gratefully acknowledge Barbara Hawkins, Kristina Lindsley, Adriani Nikolakopoulou, and Gianni Virgili for their comments to this protocol.

Version history

Published

Title

Stage

Authors

Version

2015 Dec 22

Interventions for central serous chorioretinopathy: a network meta‐analysis

Review

Mahsa Salehi, Adam S Wenick, Hua Andrew Law, Jennifer R Evans, Peter Gehlbach

https://doi.org/10.1002/14651858.CD011841.pub2

2015 Aug 17

Interventions for central serous chorioretinopathy: a network meta‐analysis

Protocol

Mahsa Salehi, Adam S Wenick, Hua Andrew Law, Jennifer R Evans, Peter Gehlbach

https://doi.org/10.1002/14651858.CD011841

Differences between protocol and review

We made the following amendments to our protocol (Salehi 2015).

  • We excluded trials of traditional Chinese medicine. This is because we did not have a clear rationale for these treatments and these interventions may not be applicable to the settings covered by this review.

  • We restricted the network to interventions applied directly to the eye (ocular interventions) because we felt that a key assumption of the network ‐ participants should be equally likely to be randomized to any of the interventions ‐ would be unlikely to hold otherwise.

  • We did not consistently contact trial investigators for clarification of risk of bias as 'unclear' based on unreported or poorly reported information: some of the studies were completed many years ago and we took the judgment that the information was unlikely to be forthcoming.

We omitted to describe the GRADE assessment and 'Summary of findings' table in our protocol and have included that in the review methods.

The following methods set out in our protocol were not done due to lack of data. They may be applicable in future editions of the review.

Unit of analysis

If any studies enroll bilateral CSC cases and randomize eyes in participants to intervention versus comparator (within‐person study), we will refer to Chapter 16 of the Cochrane Handbook for Systematic Reviews of Interventions as a guide for analysis of matched data (Higgins 2011b).

Assessing reporting bias

When future versions of this review's meta‐analysis include 10 or more studies, we will investigate small‐study effects using a funnel plot. The funnel plot will have the effect estimate on the horizontal axis and the standard error on the vertical axis for each trial. We will conduct a qualitative interpretation of funnel plot asymmetry using guidance from Chapter 10 of the Cochrane Handbook for Systematic Reviews of Interventions (Sterne 2011).

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Theoretical treatment network.
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Figure 1

Theoretical treatment network.

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Study flow diagram.
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Figure 2

Study flow diagram.

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

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

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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.
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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.

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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.
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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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Comparison 12 Antioxidant supplements versus placebo, Outcome 1 BCVA at 12 months.
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Analysis 12.1

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

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Comparison 12 Antioxidant supplements versus placebo, Outcome 2 Recurrence at 12 months.
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Analysis 12.2

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

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Comparison 12 Antioxidant supplements versus placebo, Outcome 3 Persistence at 12 months.
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Analysis 12.3

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

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Comparison 12 Antioxidant supplements versus placebo, Outcome 4 CRT at 12 months.
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Analysis 12.4

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Figuras y tablas -
Table 1. Assessment of transitivity across treatment comparisons: visual acuity
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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.

Figuras y tablas -
Table 2. Comparative effects of ocular interventions for central serous chorioretinopathy: visual acuity
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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.

Figuras y tablas -
Table 3. Assessment of transitivity across treatment comparisons: recurrence
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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.

Figuras y tablas -
Table 4. Comparative effects of ocular interventions for CSC: recurrence
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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]
Figuras y tablas -
Comparison 1. Anti‐VEGF versus observation
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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
Figuras y tablas -
Comparison 2. Anti‐VEGF versus low fluence PDT
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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
Figuras y tablas -
Comparison 3. Anti‐VEGF plus 50% PDT versus 50% PDT
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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
Figuras y tablas -
Comparison 4. Six‐dose anti‐VEGF versus four‐dose anti‐VEGF
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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
Figuras y tablas -
Comparison 5. 50% PDT versus sham treatment
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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
Figuras y tablas -
Comparison 6. 30% PDT versus PDT
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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
Figuras y tablas -
Comparison 7. 50% PDT versus PDT
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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]
Figuras y tablas -
Comparison 8. 30% PDT versus 50% PDT
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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
Figuras y tablas -
Comparison 9. Laser versus observation or sham treatment
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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
Figuras y tablas -
Comparison 10. Indirect argon laser versus direct argon laser
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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]
Figuras y tablas -
Comparison 11. Comparison of different laser wavelengths
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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
Figuras y tablas -
Comparison 12. Antioxidant supplements versus placebo
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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
Figuras y tablas -
Comparison 13. Beta‐blocker versus placebo
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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]
Figuras y tablas -
Comparison 14. Carbonic anhydrase inhibitors versus placebo
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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]
Figuras y tablas -
Comparison 15. Helicobacter pylori treatment versus placebo or observation
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