The efficacy and safety of oral and topical carbonic anhydrase inhibitors for the treatment of macular edema secondary to retinitis pigmentosa: a systematic review and meta-analysis.

PURPOSE: Carbonic anhydrase inhibitors (CAIs) are commonly used to treat macular edema (ME) secondary to retinitis pigmentosa (RP). This meta-analysis aims to better understand the efficacy of topical or oral CAIs therapy and to summarize the rates of improvement and recurrence of ME, as well as adverse events. METHODS: A systematic review was conducted by searching PubMed, Web of Science, Embase, CENTRAL, CNKI, Wanfang, and VIP databases with no language filters applied. Eligible studies were those investigating topical or oral CAIs for the treatment of ME secondary to RP. Central macular thickness (CMT) and best-corrected visual acuity (BCVA) were extracted as the primary outcome measures for comprehensive analysis. RESULTS: This meta-analysis identified a total of 16 eligible studies, encompassing 267 patients (487 eyes). Moderate certainty evidence from RCTs demonstrated that oral CAIs significantly improved BCVA, whereas topical CAIs showed no statistically significant effect. Low to moderate certainty evidence from non-RCTs revealed that both oral and topical CAIs significantly improved CMT (both P < 0.001). CONCLUSION: This meta-analysis indicates that oral CAI therapy significantly reduces CMT and improves BCVA in patients with RP, whereas the effect of topical CAIs on BCVA remains uncertain. A large-scale, prospective randomized controlled trial would be ideal to further investigate the differences in clinical efficacy and adverse events between oral and topical CAIs in this patient population.