Ford, John A., Lois, Noemi, Royle, Pamela, Clar, C., Shyangdan, D. and Waugh, Norman (2013) Current treatments in diabetic macular oedema : systematic review and meta-analysis. BMJ Open, Volume 3 (Number 3). Article no. e002269. doi:10.1136/bmjopen-2012-002269

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Abstract

Objectives: The aim of this systematic review is to
appraise the evidence for the use of anti-VEGF drugs and steroids in diabetic macular oedema (DMO) as assessed by change in best corrected visual acuity (BCVA), central macular thickness and adverse events
Data source: MEDLINE, EMBASE, Web of Science with Conference Proceedings and the Cochrane Library (inception to July 2012). Certain conference abstracts and drug regulatory web sites were also searched.
Study eligibility criteria, participants and interventions: Randomised controlled trials were used to assess clinical effectiveness and observational trials were used for safety. Trials which assessed triamcinolone, dexamethasone, fluocinolone,
bevacizumab, ranibizumab, pegaptanib or aflibercept in
patients with DMO were included.
Study appraisal and synthesis methods: Risk of bias was assessed using the Cochrane risk of bias tool. Study results are narratively described and, where appropriate, data were pooled using random effects
meta-analysis.
Results: Anti-VEGF drugs are effective compared to
both laser and placebo and seem to be more effective
than steroids in improving BCVA. They have been
shown to be safe in the short term but require frequent
injections. Studies assessing steroids (triamcinolone,
dexamethasone and fluocinolone) have reported mixed
results when compared with laser or placebo. Steroids
have been associated with increased incidence of
cataracts and intraocular pressure rise but require
fewer injections, especially when steroid implants are
used.
Limitations: The quality of included studies varied
considerably. Five of 14 meta-analyses had moderate
or high statistical heterogeneity.
Conclusions and implications of key findings:
The anti-VEGFs ranibizumab and bevacizumab have
consistently shown good clinical effectiveness without
major unwanted side effects. Steroid results have been
mixed and are usually associated with cataract
formation and intraocular pressure increase. Despite
the current wider spectrum of treatments for DMO,
only a small proportion of patients recover good vision
(≥20/40), and thus the search for new therapies needs
to continue.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RE Ophthalmology R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) > Warwick Evidence Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Blindness -- Etiology, Systematic reviews (Medical research), Endocrine glands -- Diseases, Diabetes -- Complications, Diabetic retinopathy, Vascular endothelial growth factors, Meta-analysis
Journal or Publication Title:	BMJ Open
Publisher:	BMJ
ISSN:	2044-6055
Official Date:	2013
Dates:	Date Event 2013 Published
Volume:	Volume 3
Number:	Number 3
Page Range:	Article no. e002269
DOI:	10.1136/bmjopen-2012-002269
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access

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