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Intravitreal dexamethasone implant versus anti-vascular endothelial growth factor therapy combined with cataract surgery in patients with diabetic macular oedema: a systematic review with meta-analysis

Abstract

Objective

To compare outcomes of cataract surgery combined with either anti-Vascular Endothelial Growth Factor (anti-VEGF) therapy or dexamethasone implant (DEX) in patients with diabetic macular oedema (DMO).

Methods

Pubmed and Embase databases were searched for studies reporting outcomes of diabetic cataract surgery combined with either anti-VEGF or DEX, with a follow-up ≥3 months. The primary outcome was the mean change in central macular thickness (CMT). Mean change in best corrected visual acuity (BCVA) was considered as a secondary outcome. The mean difference between baseline and post-treatment values (MD) with 95%-Confidence Interval (95%CI) was calculated and meta-analyses were performed.

Results

Nine-teen studies were included, 8 in the DEX group and 11 in the anti-VEGF group. A significant reduction of macular thickness was shown in the DEX group at 3 months (MD = −98.35 µm; 95% CI, −147.15/−49.54), while mean CMT change was non-significant in the anti-VEGF group (MD = −21.61 µm; 95% CI, −59.46/16.24; test of group differences, P < 0.001). At 3 months, no difference in visual gain was found between the two groups (P = 0.13).

Conclusions

In DMO patients, cataract surgery combined with DEX seems to provide better anatomical outcomes compared with cataract surgery combined with anti-VEGF therapy. However, our evidence was limited by significant heterogeneity. Randomised trials comparing these two different combined approaches are warranted.

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Fig. 1: One-month central macular thickness (CMT) change.
Fig. 2: Three-month central macular thickness (CMT) change.
Fig. 3: One-month best corrected visual acuity (BCVA) change.
Fig. 4: Three-month best corrected visual acuity (BCVA) change.

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Acknowledgements

We are thankful to Giorgio Pulvirenti for his contribution in data collection.

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Conceptualization, MR, MF, AA, ALotery; methodology, AM, EB, MB, GF, ALongo; investigation, MF, PM, ALongo, TA; data curation: MF, PM, AM, GF, MB, GP, AR, VB; writing—original draft preparation, VB, AR, CF, GC, EB; writing—review and editing, all authors; supervision, TA, ALotery, MR, AA. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Matteo Fallico.

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AL has consulted for Novartis Pharmaceuticals, Allergan, Janssen and Gyroscope Therapeutics. Other authors declare no competing interests.

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Fallico, M., Lotery, A., Maugeri, A. et al. Intravitreal dexamethasone implant versus anti-vascular endothelial growth factor therapy combined with cataract surgery in patients with diabetic macular oedema: a systematic review with meta-analysis. Eye 36, 2239–2246 (2022). https://doi.org/10.1038/s41433-021-01847-w

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