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Review
. 2018 May 21;18(1):121.
doi: 10.1186/s12886-018-0779-1.

A meta-analysis of the effect of a dexamethasone intravitreal implant versus intravitreal anti-vascular endothelial growth factor treatment for diabetic macular edema

Ye He  1 , Xin-Jun Ren  1 , Bo-Jie Hu  1 , Wai-Ching Lam  2 , Xiao-Rong Li  3
Affiliations
Review

A meta-analysis of the effect of a dexamethasone intravitreal implant versus intravitreal anti-vascular endothelial growth factor treatment for diabetic macular edema

Ye He et al. BMC Ophthalmol. .

Abstract

Background: 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).

Methods: The 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.

Results: Based 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.

Conclusions: Compared 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.

Keywords: Anti-VEGF; Dexamethasone implant; Diabetic macular edema; Meta-analysis; Ozurdex.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow chart of the literature search
Fig. 2
Fig. 2
Assessment of the risk of bias in included studies. a Risk of bias summary: review authors’ judgements about each risk of bias item for each included study. +: low risk of bias; −: high risk of bias;?: unclear risk of bias. b Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies
Fig. 3
Fig. 3
A forest plot diagram showing the mean BCVA and the associated 95% CI, comparing DEX with Anti-VEGF treatment at 6 months
Fig. 4
Fig. 4
A forest plot diagram showing the mean change in BCVA and the associated 95% CI, comparing DEX with Anti-VEGF treatment at 6 months and 12 months
Fig. 5
Fig. 5
A forest plot diagram showing the mean CST and the associated 95% CI, comparing DEX with Anti-VEGF treatment at 6 months
Fig. 6
Fig. 6
A forest plot diagram showing the mean change in CST and the associated 95% CI, comparing DEX with Anti-VEGF treatment at 6 months and 12 months
Fig. 7
Fig. 7
A forest plot diagram showing the total serious adverse events
Fig. 8
Fig. 8
A forest plot diagram showing the elevation of IOP
Fig. 9
Fig. 9
A forest plot diagram showing the adverse events: cataract
See this image and copyright information in PMC

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