Diabetic macular edema
systematic review of its invasive treatment 2023-2024
DOI:
https://doi.org/10.70313/2718.7446.v17.n04.382Keywords:
diabetic macular edema, anti-VEGF, corticosteroids, laser, diabetes, diabetic retinopathyAbstract
Objective: To review the current evidence on the efficacy of different invasive treatments for diabetic macular edema.
Methods: A systematic review included studies that analyzed intravitreal therapeutics (anti-VEGF, corticosteroids) and laser therapy. PubMed included only systematic reviews and meta-analyses from 2023 and 2024. In each study, the number of studies included, eyes treated, follow-up time, the treatment or procedure used, and the anatomic and functional outcomes were evaluated.
Results: Thirteen systematic reviews and meta-analyses published between 2023 and 2024 were included, which together analyzed 168 studies with a total of 26189 eyes, treated with anti-VEGF alone or in combination with laser therapy or corticosteroids, with a range of 55 days to 24 months of follow-up. Laser treatment for DME was used in 4 studies, which expressed anatomic-functional improvement, combining subthreshold micropulse laser and anti-VEGF, including less need for intravitreal injections at 12 months. Corticosteroids (dexamethasone implants or triamcinolone injections) alone or in combination with anti-VEGF had more complications (ocular hypertension and cataracts). Anti-VEGF demonstrated anatomic-functional improvement even at 24 months; there was no evidence of anatomic-functional superiority among the anti-VEGFs evaluated.
Conclusion: Anti-VEGFs achieve anatomic-functional improvements in DME, without being able to demonstrate that one is superior to another in this aspect. Anti-VEGF combined with subthreshold micropulse laser treatment decreases the number of injections required. The usefulness of anti-VEGF combined with corticosteroids in their different intraocular presentations is unclear due to their adverse effects.
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