Meta-analysis and review on the effect of bevacizumab in diabetic macular edema

• Published in: Graefe's archive for clinical and experimental ophthalmology 2011, Vol.249 (1), p.15-27
• Main Authors: Goyal, Sunali, LaValley, Michael, Subramanian, Manju L.
• Format: Article
• Language: English
• Subjects: Angiogenesis Inhibitors - therapeutic use; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Bevacizumab; Combined Modality Therapy; Diabetic Retinopathy - drug therapy; Drug Therapy, Combination; Glucocorticoids - therapeutic use; Humans; Intravitreal Injections; Laser Coagulation; Macula Lutea - pathology; Macular Edema - drug therapy; Medicine; Medicine & Public Health; Ophthalmology; Retinal Disorders; Treatment Outcome; Triamcinolone Acetonide - therapeutic use; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity - physiology
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-010-1452-4

Background Systematic review and meta-analysis to evaluate the effect of bevacizumab (Avastin) in diabetic macular edema (DME) Methods Pertinent publications were identified through systematic searches of PUBMED and Cochrane Central Register of Controlled Trials. Change in central subfield macular thickness (CSMT) in μm and best-corrected visual acuity (BCVA) in log MAR equivalents were extracted at 6, 12 and 24 weeks, and results compared between groups receiving intravitreal bevacizumab (IVB), a combination of IVB and intravitreal triamcinolone acetonide (IVT), and macular laser photocoagulation or sham control groups. Results The summary mean difference indicated a statistically significant reduction in CSMT at 6 weeks when treated with bevacizumab compared to control. IVB treatment, however, lost significance at 12 weeks and 24 weeks. The summary mean difference in BCVA for IVB group compared to control reached significance only at 6 and 24 weeks. Combination therapy of IVB and IVT did not result in any significant reduction in CSMT or gain in vision compared to treatment with IVB alone at any point in time. Conclusions Current data suggests that IVB is an effective short-term treatment for diabetic macular edema, and that its efficacy wanes after 6 weeks. More trials exploring the therapeutic role of intravitreal bevacizumab in DME need to be conducted to define the role of bevacizumab.