A meta-analysis of clinical outcomes in diabetic macular edema.

OBJECTIVE: To compare the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF), steroid, and laser on best-corrected visual acuity (BCVA), central retinal thickness (CRT), and treatment frequency in patients with diabetic macular edema. METHODS: PubMed, EMBASE, and Web of Science were systematically searched from inception to August 2024. Mean change from baseline in BCVA (mcBCVA), mean change from baseline in CRT (mcCRT), and treatment frequency were collected using PRISMA guidelines. Statistical analysis was done on 20 studies using Review Manager 5.4.1. RESULTS: mcBCVA (mean difference (MD) = 0.14 logMAR, 95% confidence interval (CI): 0.05 to 0.23, P = 0.002) and mcCRT (MD = 38.73 μm, 95% CI: 13.39 to 64.08, P = 0.003) were significantly improved in the anti-VEGF group compared to laser. mcCRT (MD = -61.17 μm, 95% CI: -106.07 to -16.27, P = 0.008) was significantly greater in the steroid group compared to anti-VEGF. Mean number of treatments per year was significantly lower in the steroid treatment group compared to anti-VEGF (MD = -4.29, 95% CI: -4.5 to -4.09, P < 0.00001). In the anti-VEGF subgroup, mcCRT was significantly greater in the aflibercept group (MD = -37.52 μm, 95% CI: -62.97 to -12.07, P = 0.004) when compared to bevacizumab. CONCLUSIONS: These data suggest anti-VEGF treatment is more effective than laser at improving BCVA and CRT, whereas steroid treatment is more effective than anti-VEGF at improving CRT outcomes. Steroid therapy, while not currently allotted a first-line therapy in the United States, may have a more significant role in reducing treatment burden and improving macular morphology.