To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare.7223939.
In this meta-analysis, we aimed to assess the possible benefits of macular photocoagulation (MPC) as an additional treatment with intravitreal bevacizumab (IVB) in patients with diabetic macular edema.
The studies were identified from three databases: PubMed, Web of Science, and the Cochrane Library. The main outcome measures included change in best-corrected visual acuity (BCVA), differences in central macular thickness (CMT), and adverse events within the follow-up period. The results were pooled using weight mean difference with their corresponding 95% confidence intervals. A fixed or random effects model was employed, depending on the heterogeneity of the inclusion trials.
Finally, three randomized controlled trial and two high-quality retrospective studies were identified and included. Changes in CMT at 1, 3, and 6 months did not vary significantly between the IVB-alone group and the IVB with MPC group (P = 0.26, 0.06, and 0.65, respectively). Similarly, changes in BCVA at 1, 3, and 6 months also did not vary significantly between the two groups (P = 0.20, 0.91, and 0.70, respectively). Whereas substantial heterogeneity was detected in the CMT results among these studies, the sensitivity analyses showed Solaiman’s study was probably the source of the heterogeneity. No publication bias was detected by funnel plots in this study.
Results of this meta-analysis showed that the treatments with IVB alone and combined IVB and MPC were similarly effective in improving BCVA and reducing CMT. However, more evidence is needed to evaluate their effects in the long-term periods.
Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414(6865):782–7. CrossRef
Ciulla TA, Amador AG, Zinman B. Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies. Diabetes Care. 2003;26(9):2653–64. CrossRef
Antcliff RJ, Marshall J. The pathogenesis of edema in diabetic maculopathy. Semin Ophthalmol. 1999;14(4):223–32. CrossRef
Photocoagulation for Diabetic Macular Edema. Early treatment diabetic retinopathy study report number 1. Early treatment diabetic retinopathy study research group. Arch Ophthalmol. 1985;103(12):1796–806. CrossRef
Schatz H, Madeira D, McDonald HR, Johnson RN. Progressive enlargement of laser scars following grid laser photocoagulation for diffuse diabetic macular edema. Arch Ophthalmol. 1991;109(11):1549–51. CrossRef
Lee CM, Olk RJ. Modified grid laser photocoagulation for diffuse diabetic macular edema. Long-term visual results. Ophthalmology. 1991;98(10):1594–602. CrossRef
Olk RJ. Modified grid argon (blue-green) laser photocoagulation for diffuse diabetic macular edema. Ophthalmology. 1986;93(7):938–50. CrossRef
Haritoglou C, Kook D, Neubauer A, Wolf A, Priglinger S, Strauss R, et al. Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema. Retina. 2006;26(9):999–1005. CrossRef
Lam DS, Lai TY, Lee VY, Chan CK, Liu DT, Mohamed S, et al. Efficacy of 1.25 MG versus 2.5 MG intravitreal bevacizumab for diabetic macular edema: six-month results of a randomized controlled trial. Retina. 2009;29(3):292–9. CrossRef
Arevalo JF, Fromow-Guerra J, Quiroz-Mercado H, Sanchez JG, Wu L, Maia M, et al. Primary intravitreal bevacizumab (Avastin) for diabetic macular edema: results from the Pan-American Collaborative Retina Study Group at 6-month follow-up. Ophthalmology. 2007;114(4):743–50. CrossRef
Seo JW, Park IW. Intravitreal bevacizumab for treatment of diabetic macular edema. Korean J Ophthalmol. 2009;23(1):17–22. CrossRef
Lynch SS, Cheng CM. Bevacizumab for neovascular ocular diseases. Ann Pharmacother. 2007;41(4):614–25. CrossRef
Soheilian M, Ramezani A, Bijanzadeh B, Yaseri M, Ahmadieh H, Dehghan MH, et al. Intravitreal bevacizumab (avastin) injection alone or combined with triamcinolone versus macular photocoagulation as primary treatment of diabetic macular edema. Retina. 2007;27(9):1187–95. CrossRef
Solaiman KA, Diab MM, Abo-Elenin M. Intravitreal bevacizumab and/or macular photocoagulation as a primary treatment for diffuse diabetic macular edema. Retina. 2010;30(10):1638–45. CrossRef
Krohne TU, Eter N, Holz FG, Meyer CH. Intraocular pharmacokinetics of bevacizumab after a single intravitreal injection in humans. Am J Ophthalmol. 2008;146(4):508–12. CrossRef
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. CrossRef
Stang A. Critical evaluation of the Newcastle–Ottawa Scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5. CrossRef
Arevalo JF, Lasave AF, Wu L, Diaz-Llopis M, Gallego-Pinazo R, Alezzandrini AA, et al. Intravitreal bevacizumab plus grid laser photocoagulation or intravitreal bevacizumab or grid laser photocoagulation for diffuse diabetic macular edema: results of the Pan-American Collaborative Retina Study Group at 24 months. Retina. 2013;33(2):403–13. CrossRef
Lee SJ, Kim ET, Moon YS. Intravitreal bevacizumab alone versus combined with macular photocoagulation in diabetic macular edema. Korean J Ophthalmol. 2011;25(5):299–304. CrossRef
Faghihi H, Esfahani MR, Harandi ZA, Madani S. Intravitreal bevacizumab vs. combination of intravitreal bevacizumab plus macular photocoagulation in clinically significant diabetic macular edema: 6 months results of a randomized clinical trial. Iran J Ophthalmol. 2010;22(1):21–6.
Javanovic S, Canadanovic V, Sabo A, Grgic Z, Mitrovic M, Rakic D. Intravitreal bevacizumab injection alone or combined with macular photocoagulation compared to macular photocoagulation as primary treatment of diabetic macular edema. Vojnosanit Pregl. 2015;72(10):876–82. CrossRef
Romero-Aroca P. Current status in diabetic macular edema treatments. World J Diabetes. 2013;4(5):165–9. CrossRef
Fortin P, Mintzes B, Innes M. A systematic review of intravitreal bevacizumab for the treatment of diabetic macular edema. CADTH Technol Overv. 2013;3(1):e3203. PubMed
Forte R, Cennamo G, Breve MA, Vecchio EC, de Crecchio G. Functional and anatomic response of the retina and the choroid to intravitreal bevacizumab for macular edema. J Ocul Pharmacol Ther. 2012;28(1):69–75. CrossRef
Kook D, Wolf A, Kreutzer T, Neubauer A, Strauss R, Ulbig M, et al. Long-term effect of intravitreal bevacizumab (avastin) in patients with chronic diffuse diabetic macular edema. Retina. 2008;28(8):1053–60. CrossRef
Shimura M, Nakazawa T, Yasuda K, Shiono T, Iida T, Sakamoto T, et al. Comparative therapy evaluation of intravitreal bevacizumab and triamcinolone acetonide on persistent diffuse diabetic macular edema. Am J Ophthalmol. 2008;145(5):854–61. CrossRef
Solaiman KA, Diab MM, Dabour SA. Repeated intravitreal bevacizumab injection with and without macular grid photocoagulation for treatment of diffuse diabetic macular edema. Retina. 2013;33(8):1623–9. CrossRef
Eriksson U, Alm A, Bjarnhall G, Granstam E, Matsson AW. Macular edema and visual outcome following cataract surgery in patients with diabetic retinopathy and controls. Graefes Arch Clin Exp Ophthalmol. 2011;249(3):349–59. CrossRef
Otani T, Kishi S. Tomographic findings of foveal hard exudates in diabetic macular edema. Am J Ophthalmol. 2001;131(1):50–4. CrossRef
Macky TA, Mahgoub MM. The effect of glycemic control on visual and anatomic outcomes in response to therapy for diabetic macular edema. Eur J Ophthalmol. 2012;23:100.
Matsuda S, Tam T, Singh RP, Kaiser PK, Petkovsek D, Carneiro G, et al. The impact of metabolic parameters on clinical response to VEGF inhibitors for diabetic macular edema. J Diabetes Complic. 2014;28(2):166–70. CrossRef
Ucgun NI, Yildirim Z, Kilic N, Gursel E. The importance of serum lipids in exudative diabetic macular edema in type 2 diabetic patients. Ann N Y Acad Sci. 2007;1100:213–7. CrossRef
Lopes de Faria JM, Jalkh AE, Trempe CL, McMeel JW. Diabetic macular edema: risk factors and concomitants. Acta Ophthalmol Scand. 1999;77(2):170–5. CrossRef
Lee CM, Olk RJ, Akduman L. Combined modified grid and panretinal photocoagulation for diffuse diabetic macular edema and proliferative diabetic retinopathy. Ophthalmic Surg Lasers. 2000;31(4):292–300. PubMed
- Effect of Intravitreal Bevacizumab with or without Macular Photocoagulation for Diabetic Macular Edema: A Meta-Analysis
- Springer Healthcare
Research, treatment and education of diabetes and related disorders
Print ISSN: 1869-6953
Elektronische ISSN: 1869-6961
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II