Abstract
BackgroundThis meta-analysis evaluated the effectiveness and safety of dexamethasone (DEX) implant and intravitreal anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME).MethodsThe PubMed, Embase, clinicaltrials.gov website and Cochrane Library databases were comprehensively searched for studies comparing DEX implant with anti-VEGF in patients with DME. Best-corrected visual acuity (BCVA), central subfield thickness (CST) and adverse events were extracted from the final eligible studies. Review Manager (RevMan) 5.3 for Mac was used to analyze the data and GRADE profiler were used to access the quality of outcomes.ResultsBased on four randomized clinical trials assessing a total of 521 eyes, the DEX implant can achieve visual acuity improvement for DME at rates similar to those achieved via anti-VEGF treatment (mean difference [MD] = − 0.43, P = 0.35), with superior anatomic outcomes at 6 months (MD = − 86.71 μm, P = 0.02), while requiring fewer injections, in comparison to anti-VEGF treatment. Although the mean reduction in CST did not showed significant difference at 12 months (MD = − 33.77 μm, P = 0.21), the significant in BCVA from baseline to 12 months supported the anti-VEGF treatment (MD = − 3.26, P < 0.00001). No statistically significant differences in terms of the serious adverse events. However, use of the DEX implant has higher risk of intraocular pressure elevation and cataract than anti-VEGF treatment.ConclusionsCompared with anti-VEGF, DEX implant improved anatomical outcomes significantly. However, this did not translate to improved visual acuity, which may be due to the progression of cataract. Therefore, the DEX implant may be recommended as a first chioce for select cases, such as for pseudophakic eyes, anti-VEGF-resistant eyes, or patients reluctant to receive intravitreal injections frequently.
Highlights
This meta-analysis evaluated the effectiveness and safety of dexamethasone (DEX) implant and intravitreal anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME)
Inclusion and exclusion criteria Studies were regarded eligible if they accord with the following criterias: (1) the study population included patients with DME; (2) the DEX implant (Ozurdex) was included as an intervention; (3) there was a comparison between the DEX implant (Ozurdex®) and anti-VEGF
Search results A total of 176 potential records up to August 2017 were identified with the electronic-based search
Summary
This meta-analysis evaluated the effectiveness and safety of dexamethasone (DEX) implant and intravitreal anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular edema (DME). Diabetic macular edema (DME) is macular thickening secondary to diabetic retinopathy (DR) that may be present in any of the stages of this disease, it manifests more commonly in the nonproliferative diabetic retinopathy stage. In patients with DR, aged 20 to 79 years, the global prevalence for DME is 6.8% [3]. The prevalence of DME is reported to be related to the duration of the diabetes [4, 5]. DME is the foremost cause of central vision loss, and even blindness, and has a great influence on life quality of patients. Reduction of ME may be associated with improved vision
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