Abstract
BackgroundTo evaluate the efficacy and safety of different intravitreal corticosteroids for treating diabetic macular edema (DME).MethodsFour databases were systematically searched for randomized controlled trials comparing different intravitreal corticosteroids for treating DME. The primary outcome was the change in best-corrected visual acuity (BCVA) within 6 months after the first injection (short-term BCVA). Secondary outcomes were the change in BCVA over 1 year (long-term BCVA) and changes in central macular thickness (CMT) and intraocular pressure (IOP) within 6 months after the first injection. Network meta-analysis was performed to aggregate the results from the individual studies.ResultsNineteen trials involving 2839 eyes were included. Intravitreal triamcinolone acetonide (TA) injections (≥ 8 mg and 4–8 mg), fluocinolone acetonide (FA) implants (0.5 µg/day) and dexamethasone (DEX) implants (700 µg) improved short-term BCVA (mean changes in logMAR [95% confidence interval] − 0.27 [− 0.40, − 0.15]; − 0.12 [− 0.18, − 0.06]; − 0.10 [− 0.21, − 0.01]; and − 0.06 [− 0.11, − 0.01]). Intravitreal TA injections (4 mg, multiple times), FA implants (0.5 µg/day and 0.2 µg/day), and DEX implants (350 µg) improved long-term BCVA (mean changes in logMAR [95% confidence interval] − 0.11 [− 0.21, − 0.02]; − 0.09 [− 0.15, − 0.03]; − 0.09 [− 0.14, − 0.02]; and − 0.04 [− 0.07, − 0.01]). All intravitreal corticosteroids reduced CMT, and different dosages of TA did not show significant differences in increasing IOP.ConclusionsIntravitreal corticosteroids effectively improved BCVA in DME patients, with higher dosages showing greater efficacies. TA was not inferior to FA or DEX and may be considered a low-cost alternative choice for DME patients. The long-term efficacy and safety of different corticosteroids deserve further investigation.Trial registration Prospectively registered: PROSPERO, CRD42020219870
Highlights
To evaluate the efficacy and safety of different intravitreal corticosteroids for treating diabetic macular edema (DME)
For the central macular thickness (CMT) measurement, seven trials were based on timedomain optical coherence tomography (OCT), one on spectral-domain OCT, one on a retinal thickness analyzer, and three without device information (Additional file 1: Table S1)
The results showed that intravitreal triamcinolone acetonide (TA) injections, fluocinolone acetonide (FA) implants, and DEX implants could improve best-corrected visual acuity (BCVA) in both the short and long term in patients with DME
Summary
To evaluate the efficacy and safety of different intravitreal corticosteroids for treating diabetic macular edema (DME). Recent observational studies shed light on the effectiveness of corticosteroids for treating both naïve and refractory eyes and ameliorating the disorganization of retinal inner layers [15,16,17]. Three systematic reviews and meta-analyses have been performed to investigate the effect of intravitreal corticosteroids on DME patients. The first study, published in 2008, concluded that intravitreal corticosteroids might improve visual outcomes in patients with persistent or refractory DME [18]. The second study, published in 2015, concluded that slow-release corticosteroid implants are effective for treating macular edema [19]. A recent meta-analysis published in 2021 confirmed favorable visual and anatomical outcomes following fluocinolone acetonide (FA) insertion for chronic DME [20]
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