Kadek Rina Agustinawati, Putu Emilia Dewi, Cynthia Dewi, Ni Made Ari Suryathi, Komang Krisna Nugraha Wirasatya

Comparative efficacy of intravitreal anti-VEGF therapy in diabetic macular edema: a systematic review and meta-analysis of randomized controlled trials

Introduction

Comparative efficacy of intravitreal anti-vegf therapy in diabetic macular edema: a systematic review and meta-analysis of randomized controlled trials. Systematic review & meta-analysis on anti-VEGF therapy for diabetic macular edema (DME). Finds significant vision improvement & reduced retinal thickness at 12 months. Superior to laser; sustained treatment crucial.

Abstract

Introduction: Diabetic macular edema (DME) is a leading cause of vision loss in diabetic patients. This systematic review and meta-analysis aimed to evaluate the efficacy of intravitreal anti-VEGF therapy compared primarily with laser photocoagulation and sham injection, with secondary analyses including alternative anti-VEGF agents or regimens in adults with DME. Methods: We searched PubMed, ScienceDirect, and Scopus for randomized controlled trials comparing anti-VEGF therapy with laser photocoagulation, sham injection, or alternative anti-VEGF agents or regimens. Primary outcomes were best-corrected visual acuity (BCVA) and central retinal thickness (CRT) at 12 and 24 months. Random-effects meta-analyses were performed with heterogeneity assessment using I² statistics. Result: Eleven RCTs (2,268 participants) were included. At 12 months, anti-VEGF therapy showed significant superiority for BCVA (mean difference +4.42 letters, 95% CI 1.11-7.73, p=0.009; I²=92%) and CRT (−61.37 μm, 95% CI −80.22 to −18.08, p=0.002; I²=81%). Benefits were particularly significant compared with laser photocoagulation (BCVA: +6.22 letters, I²=10%; CRT: −61.37 μm, I²=0%). At 24 months, treatment effects converged with no significant differences. Conclusion: Intravitreal anti-VEGF therapy demonstrates significant superiority over controls at 12 months for DME, particularly versus laser photocoagulation. Sustained treatment is essential for maintaining long-term benefits.

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