Intravitreal steroids for macular edema in diabetes

• Published in: Cochrane database of systematic reviews 2008-01 (1), p.CD005656-CD005656
• Main Authors: Grover, D, Li, T J, Chong, C C W
• Format: Article
• Language: English
• Subjects: Anti-Inflammatory Agents - administration & dosage; Dexamethasone - administration & dosage; Diabetic Retinopathy - complications; Drug Implants; Fluocinolone Acetonide - administration & dosage; Glucocorticoids - administration & dosage; Humans; Injections - methods; Macular Edema - drug therapy; Macular Edema - etiology; Randomized Controlled Trials as Topic; Steroids - administration & dosage; Triamcinolone - administration & dosage; Visual Acuity - drug effects; Vitreous Body
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD005656.pub2

Macular edema is secondary to leakage from diseased retinal capillaries and is an important cause of poor central visual acuity in patients with diabetic retinopathy. This review evaluated the effectiveness and safety of intraocular steroids in treating diabetic macular edema (DME). We searched CENTRAL, MEDLINE, EMBASE in June 2007, reference lists, Science Citation Index and conference proceedings. We included randomized clinical trials (RCTs) evaluating any form of intravitreal steroids for treating DME. Two authors independently assessed eligibility, methodological quality and extracted data. We performed meta-analyses when appropriate. Seven studies, involving 632 DME eyes were included. Four examined the effectiveness of intravitreal triamcinolone acetate injection (IVTA), three examined intravitreal steroids implantation (fluocinolone acetonide implant (FAI) or dexamethasone drug delivery system (DDS)). Two trials were at low risk of bias, one was at median risk of bias, two were at high risk of bias and the remaining two were at unclear risk of bias. The preponderance of data suggest a beneficial effect from IVTA. Comparing IVTA with controls, the mean difference in visual acuity was -0.15 LogMAR (95% CI -0.21 to -0.09) at 3 months (based on three trials), -0.23 LogMAR (95% CI -0.33 to -0.13) at 6 months (two trials), -0.29 LogMAR (95% CI -0.47 to -0.11) at 9 months (one trial), and -0.11 LogMAR (95% CI -0.20 to -0.03) at 24 months (one trial), all in favor of IVTA. The relative risk (RR) for one or more lines improvement in visual acuity was 2.85 (95% CI 1.59 to 5.10) at 3 months (two trials), 1.25 (95% CI 0.66 to 2.38) at 6 months (one trial), and 2.17 (95% CI 1.15 to 4.11) at 24 months (one trial), all in favor of IVTA. We did not find evidence for three or more lines improvement in visual acuity. The mean difference in retinal thickness was -131.97 um (95% CI -169.08 to -94.86) at 3 months (two trials), -135.00 um (95% CI -194.50 to -75.50) at 6 months (one trial), -133.00 um (95% CI -199.86 to -66.14) at 9 months (one trial), and -59.00 um (95% CI -103.50 to -14.50) at 24 months (one trial), all in favor of IVTA. The RR for at least one grade macular edema resolution was 5.15 (95% CI 2.23 to 11.88) at 3 months in favor of IVTA (one trial). Two trials reported improved clinical outcome when FAI was compared to standard of care. Beneficial effect was also observed in one dexamethasone DDS trial. Increased intraocular pressure and cataract formati