Managing Diabetic Macular Edema in Clinical Practice: Systematic Review and Meta-Analysis of Current Strategies and Treatment Options

This meta-analysis aims to summarize 12-month best-corrected visual acuity (BCVA) outcomes in response to anti-vascular endothelial growth factor (VEGF) therapy and dexamethasone implant for the treatment of diabetic macular edema (DME) and to identify factors affecting treatment response using evid...

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Bibliographic Details
Published in:Clinical ophthalmology (Auckland, N.Z.) N.Z.), 2021-01, Vol.15, p.375-385
Main Authors: Veritti, Daniele, Sarao, Valentina, Soppelsa, Valentina, Lanzetta, Paolo
Format: Article
Language:English
Subjects:
aflibercept
anti-vegf
bevacizumab
Care and treatment
Clinical medicine
Dexamethasone
Diabetes
diabetic macular edema
Diabetic retinopathy
Diabetics
Dropsy
Edema
Evidence-based medicine
Immunotherapy
Influence
Literature reviews
Medical research
Medicine, Experimental
Meta-analysis
Monoclonal antibodies
Patients
ranibizumab
Review
Steroids
Systematic review
Vascular endothelial growth factor
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Summary:This meta-analysis aims to summarize 12-month best-corrected visual acuity (BCVA) outcomes in response to anti-vascular endothelial growth factor (VEGF) therapy and dexamethasone implant for the treatment of diabetic macular edema (DME) and to identify factors affecting treatment response using evidence generated from meta-regression. A systematic review of electronic databases was conducted to identify randomized controlled trials (RCTs) and real-life/observational studies that reported 12-month changes in BCVA in patients with DME on anti-VEGF or dexamethasone implant treatment in monotherapy. Study factors that were analyzed are baseline patient characteristics, study type, drug employed, number of injections and 12-month change in BCVA. Data were pooled in a random-effects meta-analysis with BCVA change as the main outcome. Meta-regression was conducted to assess the impact of multiple covariates. One-hundred-five heterogeneous study populations (45,032 eyes) were identified and included in the analysis. The use of anti-VEGFs and dexamethasone implant induced an overall increase of +8.13 ETDRS letters in BCVA at 12 months of follow-up. Meta-regression provided evidence that mean BCVA change using anti-VEGFs was not statistically higher for RCTs (p=0.35) compared to observational studies. Dexamethasone implant showed a trend for better results in observational studies over RCTs. Populations following a fixed aflibercept regimen performed better than those following a reactive treatment regimen. Mean BCVA gain was higher in younger populations (p
ISSN:1177-5467
1177-5483
1177-5483
DOI:10.2147/OPTH.S236423