PDF(Pubmed)
Abstract：
Diabetic macular edema (DME) is a significant condition linked to diabetes that can result in visual loss. In recent times, there has been a notable change in the desire for treatment, with a shift toward anti-vascular endothelial growth factor (anti-VEGF) therapy and intravitreal steroids while moving away from conventional laser therapies. This comprehensive meta-analysis explicitly compares the efficacy of two therapies for DME: anti-VEGF therapy and corticosteroid. We conducted a thorough search using PubMed and Google Scholar to identify publications that compare the effects of anti-VEGF therapy and corticosteroid implants on DME. Using Review Manager 5.0 (RevMan), we incorporated data from nine research studies, which involved a total of 877 people. The group was split into two factions: 453 patients were administered corticosteroids, while 466 patients underwent treatment with anti-VEGF therapy. Our investigation demonstrated that both corticosteroid and anti-VEGF therapy positively improved the best-corrected visual acuity (BCVA) and reduced the central macular thickness (CMT). Nevertheless, comparing the mean BCVA on the logarithm of the minimum angle of resolution (logMAR) scale revealed no statistically significant changes between the two treatments. This indicates considerable inconsistency, as evidenced by the weighted mean difference (WMD) of -0.13 (-0.41, 0.16) with a P-value of 0.39 and an I2 value of 99%. In addition, both treatments improved BCVA compared to the initial measurement. However, there was no statistically significant benefit for corticosteroid over anti-VEGF therapy, as indicated by the WMD of 0.03 (-0.07, 0.13) with a P-value of 0.55 and an I2 value of 80%. The examination of the average CMT also yielded findings that lacked statistical significance, displaying a significant amount of variation (WMD -36.37, 95% confidence interval [-127.52, 54.78], P = 0.43, I2 = 98%). Remarkably, there were no significant alterations among the anti-VEGF therapy group despite a rise in CMT from the initial measurement. The main conclusion drawn from our research is that corticosteroid demonstrates encouraging immediate enhancements in BCVA and CMT. However, anti-VEGF therapy seems to provide more significant long-term advantages. Nevertheless, it is crucial to acknowledge that the corticosteroid group had a greater susceptibility to acquiring elevated intraocular pressure (IOP) and the possibility of glaucoma.
摘要：
糖尿病性黄斑水肿（DME）是与糖尿病相关的重要疾病，可导致视力丧失。最近,治疗的愿望有了显著的变化，转向抗血管内皮生长因子（抗VEGF）治疗和玻璃体内类固醇治疗，同时远离传统的激光治疗。这项全面的荟萃分析明确比较了两种治疗DME的疗效：抗VEGF治疗和皮质类固醇治疗。我们使用PubMed和GoogleScholar进行了全面搜索，以确定比较抗VEGF治疗和皮质类固醇植入物对DME影响的出版物。使用ReviewManager5.0(RevMan)，我们纳入了九项研究的数据，共涉及877人。该小组分为两个派系：453名患者接受了皮质类固醇治疗，而466例患者接受了抗VEGF治疗。我们的研究表明，皮质类固醇和抗VEGF治疗均可积极改善最佳矫正视力（BCVA）并降低中央黄斑厚度（CMT）。然而，比较最小分辨角(logMAR)标度对数的平均BCVA显示,两种治疗之间无统计学显著变化.这表明相当不一致，加权平均差（WMD）为-0.13（-0.41，0.16），P值为0.39，I2值为99％。此外,与初始测量相比,两种治疗方法均提高了BCVA.然而,与抗VEGF治疗相比，皮质类固醇无统计学意义的获益，WMD为0.03（-0.07，0.13），P值为0.55，I2值为80％。对平均CMT的检查也得出了缺乏统计学意义的发现，显示显著的变异量(WMD-36.37，95%置信区间[-127.52，54.78]，P=0.43，I2=98%）。值得注意的是,抗VEGF治疗组没有显著改变,尽管CMT从初始测量值开始升高.从我们的研究中得出的主要结论是，皮质类固醇在BCVA和CMT中表现出令人鼓舞的立即增强。然而,抗VEGF治疗似乎提供了更显著的长期优势.然而，重要的是要认识到皮质类固醇组更容易出现眼内压(IOP)升高和青光眼的可能性.
