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Intravitreal corticosteroid implant vs intravitreal ranibizumab for the treatment of macular edema: a meta-analysis of randomized controlled trials

Authors Wei Q, Chen R, Lou Q, Yu J

Received 19 August 2018

Accepted for publication 19 December 2018

Published 11 January 2019 Volume 2019:13 Pages 301—307

DOI https://doi.org/10.2147/DDDT.S184520

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Qiongyu Guo


Qingquan Wei,1,2,* Rui Chen,1,2,* Qiyang Lou,1,2 Jing Yu1,2

1Department of Ophthalmology, Ninghai First Hospital, Zhejiang 315600, People’s Republic of China; 2Department of Ophthalmology, Shanghai Tenth People’s Hospital Affiliated with Tongji University, Shanghai 200072, People’s Republic of China

*These authors contributed equally to this work

Purpose: The purpose of this meta-analysis was to compare the efficacy and safety of corticosteroid implant and intravitreal ranibizumab for the treatment of macular edema (ME).
Materials and methods: PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were comprehensively searched for studies comparing dexamethasone implant with ranibizumab in patients with ME. Best-corrected visual acuity (BCVA), central subfield thickness (CST), and adverse events were extracted from the final eligible studies. RevMan 5.3 software was used to analyze the data, and the modified Jadad assessment tool was used to access the quality of outcomes.
Results: Three randomized controlled trials (RCTs) were included in our analysis. The types of causes of ME include central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and diabetic retinopathy (DR). The ranibizumab treatment group had significantly better BCVA compared with the corticosteroid treatment group (standard mean difference [SMD] -0.80; 95% CI -1.08, -0.53; P<0.00001). The ranibizumab treatment group also had higher CST reduction compared with the corticosteroid treatment group, and there was a significant difference (weighted mean difference [WMD] 167.58; 95% CI 125.21–209.95; P<0.00001). There was no significant difference in serious adverse effects between the two groups (SMD 1.67; 95% CI 0.69, 4.05; P=0.26). However, the use of corticosteroid implant had a higher risk of intraocular pressure (IOP) (OR 6.88; 95% CI 4.53–10.44; P<0.00001) elevation and cataract (OR 3.98; 95% CI 1.89–8.37; P=0.0003) than ranibizumab treatment and fewer injections.
Conclusions: Compared with ranibizumab, corticosteroid implant did not have greater improved BCVA, but corticosteroid implant had less CST reduction. The advantages of corticosteroids are fewer injections, while the advantages of ranibizumab include fewer side effects.

Keywords: macular edema, dexamethasone implant, ranibizumab, meta-analysis
 

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