Work

Concurrent macular neovascularization in shallow irregular retinal pigment epithelium elevation phenotypes in age‐related macular degeneration and chronic central serous chorioretinopathy: A systematic review and meta‐analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: This systematic review and meta‐analysis synthesized the reported frequency of concurrent macular neovascularization (MNV) among selected eyes with author‐defined shallow irregular retinal pigment epithelium (RPE) elevations in age‐related macular degeneration (AMD) and chronic central serous chorioretinopathy (CSC). Nine databases were searched on 3 May 2026 for observational studies assessing contemporaneous MNV in phenotype‐positive eyes. Studies were classified according to phenotype definition, disease context, unit of analysis and MNV ascertainment directness. Principal quantitative syntheses were restricted to clinically comparable Tier 1 eye‐level cohorts, while Tier 2 evidence was examined in a restricted sensitivity analysis. Random‐effects meta‐analysis of logit‐transformed proportions was performed separately by disease, with binomial‐normal generalized linear mixed models (GLMM) used as sensitivity analyses. Certainty was assessed using a GRADE‐style framework, and the review was registered in PROSPERO (CRD420261384416). Twenty‐two reports were included, comprising five AMD and 17 CSC reports. Three selected fellow‐eye AMD cohorts contributed 160 double‐layer sign (DLS)‐positive eyes to the principal AMD analysis; the pooled frequency of contemporaneous MNV was 52% (95% confidence interval [CI], 19%–84%; I 2 = 72.52%). Five selected chronic CSC cohorts contributed 232 flat irregular pigment epithelial detachment (FIPED)‐positive eyes to the principal CSC analysis; the pooled frequency was 43% (95% CI, 25%–63%; I 2 = 61.32%). A restricted Tier 1 plus Tier 2 CSC sensitivity analysis yielded 39% (95% CI, 23%–57%; I 2 = 77.89%). GLMM sensitivity analyses produced similar point estimates, although confidence and prediction intervals remained wide. Certainty of evidence was very low. In selected phenotype‐positive cohorts, contemporaneous MNV was identified in approximately one‐half of DLS‐positive AMD eyes and two‐fifths of FIPED‐positive chronic CSC eyes, but the estimates were imprecise. These findings should not be interpreted as diagnostic, prognostic, population‐prevalence or treatment thresholds. Structural OCT phenotypes should prompt disease‐contextualized multimodal characterization rather than stand‐alone inference of MNV activity or treatment need.

Source: Acta Ophthalmologica

DOI: 10.1111/aos.70226