Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trials
Abstract Background To evaluate the efficacy and safety of different intravitreal corticosteroids for treating diabetic macular edema (DME). Methods Four databases were systematically searched for randomized controlled trials comparing different intravitreal corticosteroids for treating DME. The pri...
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | Eye and Vision |
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| Online Access: | https://doi.org/10.1186/s40662-021-00261-3 |
| _version_ | 1818425749871263744 |
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| author | Lu Gao Xu Zhao Lei Jiao Luosheng Tang |
| author_facet | Lu Gao Xu Zhao Lei Jiao Luosheng Tang |
| author_sort | Lu Gao |
| collection | DOAJ |
| description | Abstract Background To evaluate the efficacy and safety of different intravitreal corticosteroids for treating diabetic macular edema (DME). Methods Four databases were systematically searched for randomized controlled trials comparing different intravitreal corticosteroids for treating DME. The primary outcome was the change in best-corrected visual acuity (BCVA) within 6 months after the first injection (short-term BCVA). Secondary outcomes were the change in BCVA over 1 year (long-term BCVA) and changes in central macular thickness (CMT) and intraocular pressure (IOP) within 6 months after the first injection. Network meta-analysis was performed to aggregate the results from the individual studies. Results Nineteen trials involving 2839 eyes were included. Intravitreal triamcinolone acetonide (TA) injections (≥ 8 mg and 4–8 mg), fluocinolone acetonide (FA) implants (0.5 µg/day) and dexamethasone (DEX) implants (700 µg) improved short-term BCVA (mean changes in logMAR [95% confidence interval] − 0.27 [− 0.40, − 0.15]; − 0.12 [− 0.18, − 0.06]; − 0.10 [− 0.21, − 0.01]; and − 0.06 [− 0.11, − 0.01]). Intravitreal TA injections (4 mg, multiple times), FA implants (0.5 µg/day and 0.2 µg/day), and DEX implants (350 µg) improved long-term BCVA (mean changes in logMAR [95% confidence interval] − 0.11 [− 0.21, − 0.02]; − 0.09 [− 0.15, − 0.03]; − 0.09 [− 0.14, − 0.02]; and − 0.04 [− 0.07, − 0.01]). All intravitreal corticosteroids reduced CMT, and different dosages of TA did not show significant differences in increasing IOP. Conclusions Intravitreal corticosteroids effectively improved BCVA in DME patients, with higher dosages showing greater efficacies. TA was not inferior to FA or DEX and may be considered a low-cost alternative choice for DME patients. The long-term efficacy and safety of different corticosteroids deserve further investigation. Trial registration Prospectively registered: PROSPERO, CRD42020219870 |
| first_indexed | 2024-12-14T14:18:53Z |
| format | Article |
| id | doaj.art-b13c195c2ed0484fa3f34302e372c566 |
| institution | Directory Open Access Journal |
| issn | 2326-0254 |
| language | English |
| last_indexed | 2024-12-14T14:18:53Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
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| series | Eye and Vision |
| spelling | doaj.art-b13c195c2ed0484fa3f34302e372c5662022-12-21T22:58:08ZengBMCEye and Vision2326-02542021-10-018111310.1186/s40662-021-00261-3Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trialsLu Gao0Xu Zhao1Lei Jiao2Luosheng Tang3Department of Ophthalmology, The Second Xiangya Hospital, Central South UniversityDepartment of Anesthesiology, The Second Xiangya Hospital, Central South UniversitySchool of Medicine, Taizhou UniversityDepartment of Ophthalmology, The Second Xiangya Hospital, Central South UniversityAbstract Background To evaluate the efficacy and safety of different intravitreal corticosteroids for treating diabetic macular edema (DME). Methods Four databases were systematically searched for randomized controlled trials comparing different intravitreal corticosteroids for treating DME. The primary outcome was the change in best-corrected visual acuity (BCVA) within 6 months after the first injection (short-term BCVA). Secondary outcomes were the change in BCVA over 1 year (long-term BCVA) and changes in central macular thickness (CMT) and intraocular pressure (IOP) within 6 months after the first injection. Network meta-analysis was performed to aggregate the results from the individual studies. Results Nineteen trials involving 2839 eyes were included. Intravitreal triamcinolone acetonide (TA) injections (≥ 8 mg and 4–8 mg), fluocinolone acetonide (FA) implants (0.5 µg/day) and dexamethasone (DEX) implants (700 µg) improved short-term BCVA (mean changes in logMAR [95% confidence interval] − 0.27 [− 0.40, − 0.15]; − 0.12 [− 0.18, − 0.06]; − 0.10 [− 0.21, − 0.01]; and − 0.06 [− 0.11, − 0.01]). Intravitreal TA injections (4 mg, multiple times), FA implants (0.5 µg/day and 0.2 µg/day), and DEX implants (350 µg) improved long-term BCVA (mean changes in logMAR [95% confidence interval] − 0.11 [− 0.21, − 0.02]; − 0.09 [− 0.15, − 0.03]; − 0.09 [− 0.14, − 0.02]; and − 0.04 [− 0.07, − 0.01]). All intravitreal corticosteroids reduced CMT, and different dosages of TA did not show significant differences in increasing IOP. Conclusions Intravitreal corticosteroids effectively improved BCVA in DME patients, with higher dosages showing greater efficacies. TA was not inferior to FA or DEX and may be considered a low-cost alternative choice for DME patients. The long-term efficacy and safety of different corticosteroids deserve further investigation. Trial registration Prospectively registered: PROSPERO, CRD42020219870https://doi.org/10.1186/s40662-021-00261-3Diabetic macular edemaCorticosteroidsTriamcinolone acetonideFluocinolone acetonideDexamethasoneBest-corrected visual acuity |
| spellingShingle | Lu Gao Xu Zhao Lei Jiao Luosheng Tang Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trials Eye and Vision Diabetic macular edema Corticosteroids Triamcinolone acetonide Fluocinolone acetonide Dexamethasone Best-corrected visual acuity |
| title | Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trials |
| title_full | Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trials |
| title_fullStr | Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trials |
| title_full_unstemmed | Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trials |
| title_short | Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trials |
| title_sort | intravitreal corticosteroids for diabetic macular edema a network meta analysis of randomized controlled trials |
| topic | Diabetic macular edema Corticosteroids Triamcinolone acetonide Fluocinolone acetonide Dexamethasone Best-corrected visual acuity |
| url | https://doi.org/10.1186/s40662-021-00261-3 |
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