摘要
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(0.5μg/day)and dexamethasone(DEX)implants(700μg)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(0.5μg/day and 0.2μg/day),and DEX implants(350μg)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.
基金
Support was provided by institutional and/or departmental sources.
