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Meta-Analysis
. 2024 Jul 10;19(7):e0305573.
doi: 10.1371/journal.pone.0305573. eCollection 2024.

Comparing the efficacy of dexamethasone implant and anti-VEGF for the treatment of macular edema: A systematic review and meta-analysis

Hui-Xin Tang  1 , Jing-Jing Li  1 , Ying Yuan  2 , Yun Ling  1 , Zubing Mei  3   4 , Hong Zou  1
Affiliations
Meta-Analysis

Comparing the efficacy of dexamethasone implant and anti-VEGF for the treatment of macular edema: A systematic review and meta-analysis

Hui-Xin Tang et al. PLoS One. .

Abstract

Objectives: To evaluate the clinical efficacy of dexamethasone (DEX) implant, for the treatment of macular edema (ME) caused by retinal vein occlusion (RVO) and diabetic retinopathy (DR) through a systematic review and meta-analysis.

Methods: The PubMed, Embase and Cochrane Library databases were comprehensively searched from inception to November 21, 2022, for studies evaluating the clinical efficacy of DEX implant for patients with retinal vein occlusion macular edema (RVO-ME) or diabetic macular edema (DME). Randomized controlled trials (RCTs) published in English were considered eligible. The Cochrane Collaboration tool was applied to assess the risk of bias in each study. Effect estimates with 95% confidence intervals (CIs) were pooled using the random effects model. We also conducted subgroup analyses to explore the sources of heterogeneity and the stability of the results.

Results: This meta-analysis included 8 RCTs (RVO-ME [n = 2] and DME [n = 6]) assessing a total of 336 eyes. Compared with anti-VEGF therapy, DEX implant treatment achieved superior outcomes in terms of best corrected visual acuity (BCVA) (mean difference [MD] = -3.68 ([95% CI, -6.11 to -1.25], P = 0.003), and no heterogeneity was observed (P = 0.43, I2 = 0%). DEX implant treatment also significantly reduced central macular thickness (CMT) compared with anti-VEGF treatment (MD = -31.32 [95% CI, -57.92 to -4.72], P = 0.02), and there was a high level of heterogeneity between trials (P = 0.04, I2 = 54%). In terms of severe adverse events, DEX implant treatment had a higher risk of elevated intraocular pressure than anti-VEGF therapy (RR = 6.98; 95% CI: 2.16 to 22.50; P = 0.001), and there was no significant difference in cataract progression between the two groups (RR = 1.83; 95% CI: 0.63 to 5.27, P = 0.31).

Conclusions: Compared with anti-VEGF therapy, DEX implant treatment is more effective in improving BCVA and reducing ME. Additionally, DEX implant treatment has a higher risk of elevated intraocular pressure. Due to the small number of studies and the short follow-up period, the results should be interpreted with caution. The long-term effects of the two treatments need to be further determined.

Trial registration: Prospero Registration Number CRD42021243185.

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Conflict of interest statement

NO authors have competing interests

Figures

Fig 1
Fig 1. Flow diagram of study selection.
Fig 2
Fig 2. Forest plot for meta-analysis of the effect of ME on BCVA.
Fig 3
Fig 3. Forest plot for meta-analysis of the effect of ME on CMT.
Fig 4
Fig 4. Subgroup analysis of different follow-up periods with BCVA in DME.
Fig 5
Fig 5. Subgroup analysis of different follow-up periods with CMT in DME.
Fig 6
Fig 6. Forest plot for meta-analysis of the effect of elevated IOP.
Fig 7
Fig 7. Forest plot for meta-analysis of the effect of cataract progression.
See this image and copyright information in PMC

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