Why carry out this study?
|
The clinical efficacy of intravitreously administered Conbercept (IVC) has been reported in some prospective and retrospective studies to date. However, the evidence on efficacy of IVC monotherapy for DME was still limited |
What was the evidence-based efficacy of IVC monotherapy for DME? |
What was learned from the study?
|
Our findings suggest improved VA and CMT outcomes during 1-year follow-up in patients with DME who underwent IVC monotherapy |
Increased injection frequency demonstrates a significant trend with improved outcomes at 12 months |
IVC monotherapy as the initial treatment might be a treatment option for DME |
Introduction
Methods
Compliance with Ethics Guidelines
Search Strategy, Inclusion Criteria, Exclusion Criteria, and Data Collection
Data Extraction and Risk of Bias Assessment
Statistical Analysis
Results
Study Selection
No. | Author (year) | Study design | DM type | DME type | Age (mean ± SD/range, years) | Male/female (N) | Patients (N) | Eyes (N) | No. of injections, mean (SD) | Treatment regimen | Jadad score |
---|---|---|---|---|---|---|---|---|---|---|---|
1 | Liu et al. (2019) [14] | Retrospective | Type 2 | DME | 53.9 (34–69) | 10/3 | 13 | 26 | 3 | Monthly × 3 | 3 |
2 | Li et al. (2019) [15] | Retrospective | NA | DME | 50.5 ± 3.3 (44–62) | 24/26 | 50 | 50 | 3 | Monthly × 3 | 3 |
3 | Chang et al. (2016) [16] | Retrospective | NA | CSME | 49–62 | 11/10 | 21 | 22 | 3.05 | 1 + PRN | 3 |
4 | Jiang et al. (2017) [17] | Prospective | Type 2 | CSME/CME/DDME | 54.10 ± 10.65 | 12/8 | 20 | 20 | 3.20 ± 0.52 | 3 + PRN | 4 |
5 | Guo et al. (2018) [18] | Retrospective | NA | DME | 61.35 ± 7.58 | 28/27 | 55 | 55 | 3 | Monthly × 3 | 3 |
6 | Zhang et al. (2018) [19] | Prospective | NA | DDME | 51.88 ± 10.18 | 13/12 | 25 | 25 | 1 | Monthly × 1 | 4 |
7 | Sun et al. (2018) [20] | Prospective | NA | DME | 66.52 ± 8.39 | 13/16 | 29 | 30 | 3 | Monthly × 3 | 3 |
8 | Zhang et al. (2018) [21] | Prospective | NA | DDME | 51.90 ± 10.90 | NA | 17 | 17 | 3 | Monthly × 3 | 3 |
9 | Ren et al. (2019) [22] | Prospective | NA | DDME | 59.24 ± 8.61 | NA | 35 | 35 | 1 | Monthly × 1 | 3 |
NA | CME | 62.51 ± 9.12 | 33 | 33 | 1 | Monthly × 1 | |||||
NA | SRD | 60.86 ± 9.47 | 28 | 28 | 1 | Monthly × 1 | |||||
10 | Li et al. (2019) [23] | Retrospective | NA | DME | 54 ± 5 | 24/16 | 19 | 21 | 1 | Monthly × 1 | 4 |
11 | Zhang et al. (2019) [24] | Prospective | NA | DME | NA | 17/23 | 40 | 40 | 3 | Monthly × 3 | 3 |
12 | Xu et al. (2016) [25] | Retrospective | Type 1/Type 2 | DDME | 60.9 ± 12.9 | 12/14 | 26 | 31 | 5.6 ± 0.8 | 1 + PRN | 3 |
13 | Qian (2017) [26] | Retrospective | NA | DDME | NA | NA | 33 | 40 | 5.8 ± 1.7 | 1 + PRN | 3 |
14 | Xu et al. (2017) [27] | Retrospective | Type 1/Type 2 | CSME/DDME | 61.3 ± 14.9 | 18/14 | 32 | 36 | 6.6 ± 0.9 | 3 + PRN | 3 |
15 | Li et al. (2018) [28] | Retrospective | NA | DDME | NA | 28/46 | 20 | 20 | 3.20 ± 0.4 | 1 + PRN | 3 |
CME | 36 | 36 | 3.39 ± 0.95 | 1 + PRN | |||||||
SRD | 18 | 18 | 4.22 ± 1.55 | 1 + PRN | |||||||
16 | Li et al. (2017) [10] | Retrospective | Type 2 | DME | 59.8 ± 9.8 | NA | 37 | 37 | 6.74 | 1 + PRN | 3 |
NA | DME | 54.4 ± 6.3 | NA | 25 | 25 | 6.5 | 1 + PRN | ||||
17 | Niu and Ji (2018) [29] | Prospective | Type 2 | DME | 52.8 ± 14.0 | 15/8 | 23 | 23 | 2 | 1 + PRN | 3 |
18 | Xu et al. (2019) [30] | Retrospective | NA | CSME | 60.55 ± 8.65 | 10/10 | 20 | 20 | 6.60 ± 3.02 | 3 + PRN | 3 |
19 | Zhou et al. (2019) [9] | Retrospective | NA | DME | 59.6 ± 8.5 | 46/43 | 60 | 60 | 4.5 ± 1.0 | 3 + PRN | 3 |
20 | Li et al. (2019) [31] | Prospective | NA | DME | 60.6 ± 12.3 | 19/13 | 32 | 32 | 8.58 ± 2.4 | 3 + PRN | 4 |
Change in BCVA
Subgroup restriction | Follow-up time | Number of studies | Visual testing scale | Pooled visual change (95% CI) | P | I2 (%) | Pheterogeneity |
---|---|---|---|---|---|---|---|
Retrospective | 1 month | 3 | logMAR | − 3.33 (− 5.83, − 0.84) | 0.009 | 97.2 | < 0.001 |
Prospective | 1 month | 6 | logMAR | − 0.38 (− 0.90, 0.15) | 0.159 | 81.3 | < 0.001 |
Overall pooling | 1 month | 9 | logMAR | − 1.24 (− 2.09, − 0.38) | 0.005 | 94.7 | < 0.001 |
Retrospective | 2 months | 2 | logMAR | − 3.25 (− 8.07, 1.56) | 0.185 | 97.5 | < 0.001 |
Prospective | 2 months | NA | logMAR | NA | NA | NA | NA |
Overall pooling | 2 months | 2 | logMAR | − 3.25 (− 8.07, 1.56) | 0.185 | 97.5 | < 0.001 |
Retrospective | 3 months | 4 | logMAR | − 6.09 (− 10.53, − 1.65) | 0.007 | 98.6 | < 0.001 |
Prospective | 3 months | 9 | logMAR | − 0.77 (− 1.38, − 0.17) | 0.012 | 89.3 | < 0.001 |
Overall pooling | 3 months | 13 | logMAR | − 2.30 (− 3.37, − 1.23) | < 0.001 | 97 | < 0.001 |
Retrospective | 6 months | 3 | logMAR | − 8.58 (− 17.50, 0.34) | 0.059 | 99.2 | < 0.001 |
Prospective | 6 months | 10 | logMAR | − 0.72 (− 1.29, − 0.15) | 0.013 | 89.3 | < 0.001 |
Overall pooling | 6 months | 13 | logMAR | − 1.98 (− 2.88, − 1.08) | < 0.001 | 96.4 | < 0.001 |
Retrospective | 9 months | NA | logMAR | NA | NA | NA | NA |
Prospective | 9 months | NA | logMAR | NA | NA | NA | NA |
Overall pooling | 9 months | NA | logMAR | NA | NA | NA | NA |
Retrospective | 12 months | 1 | logMAR | − 0.33 (− 0.68, 0.033) | 0.075 | NA | NA |
Prospective | 12 months | 4 | logMAR | − 0.79 (− 1.33, − 0.24) | 0.005 | 69.5 | 0.02 |
Overall pooling | 12 months | 5 | logMAR | − 0.67 (− 1.11, − 0.24) | 0.003 | 69.5 | 0.01 |
Retrospective | 1 month | 1 | ETDRS | 0.48 (− 0.116, 1.08) | 0.114 | NA | NA |
Prospective | 1 month | 1 | ETDRS | 0.62 (− 0.02, 1.25) | 0.058 | NA | NA |
Overall pooling | 1 month | 2 | ETDRS | 0.55 (0.11, 0.98) | 0.014 | 0 | 0.768 |
Retrospective | 2 months | NA | ETDRS | NA | NA | NA | NA |
Prospective | 2 months | NA | ETDRS | NA | NA | NA | NA |
Overall pooling | 2 months | NA | ETDRS | NA | NA | NA | NA |
Retrospective | 3 months | NA | ETDRS | NA | NA | NA | NA |
Prospective | 3 months | 2 | ETDRS | 0.56 (0.17, 0.95) | 0.005 | 0 | 0.374 |
Overall pooling | 3 months | 2 | ETDRS | 0.56 (0.17, 0.95) | 0.005 | 0 | 0.374 |
Retrospective | 6 months | 1 | ETDRS | 0.63 (0.03, 1.23) | 0.041 | NA | NA |
Prospective | 6 months | 2 | ETDRS | 0.64 (0.25, 1.04) | 0.001 | 0 | 0.356 |
Overall pooling | 6 months | 3 | ETDRS | 0.64 (0.31, 0.97) | < 0.001 | 0 | 0.653 |
Retrospective | 9 months | 0 | ETDRS | NA | NA | NA | NA |
Prospective | 9 months | 1 | ETDRS | 0.51 (0.01, 1.00) | 0.046 | NA | NA |
Overall pooling | 9 months | 1 | ETDRS | 0.51 (0.01, 1.00) | 0.046 | NA | NA |
Retrospective | 12 months | 6 | ETDRS | 1.12 (0.77, 1.48) | < 0.001 | 61.4 | 0.024 |
Prospective | 12 months | 1 | ETDRS | 0.51 (0.01, 1.01) | 0.044 | NA | NA |
Overall pooling | 12 months | 7 | ETDRS | 1.03 (0.69, 1.38) | < 0.001 | 61.4 | 0.008 |
Items | Follow-up time | Begg’s test | Egger’s test |
---|---|---|---|
logMAR BCVA scale | 1 month | 0.677 | 0.344 |
2 months | NA | 0.317 | |
3 months | 0.11 | 0.016 | |
6 months | 0.18 | 0.04 | |
9 months | NA | NA | |
12 months | 0.14 | 0.74 | |
ETDRS BCVA scale | 1 month | 0.32 | NA |
2 months | NA | NA | |
3 months | 0.32 | NA | |
6 months | 0.12 | 0.36 | |
9 months | NA | NA | |
12 months | 0.65 | 0.11 | |
CMT | 1 month | 0.48 | 0.049 |
2 months | 0.32 | NA | |
3 months | 0.24 | < 0.001 | |
6 months | 0.21 | 0.04 | |
9 months | NA | NA | |
12 months | 0.17 | 0.28 |
Change in CMT
Subgroup restriction | Follow-up time | Number of studies | Pooled visual change (95% CI) | P | I2 (%) | Pheterogeneity |
---|---|---|---|---|---|---|
Retrospective | 1 month | 5 | − 213.92 (− 295.78, − 132.06) | < 0.001 | 92.3 | < 0.001 |
Prospective | 1 month | 6 | − 76.565 (− 97.29, − 55.84) | < 0.001 | 20.4 | 0.28 |
Overall pooling | 1 month | 11 | − 141.48 (− 193.15, − 89.81) | < 0.001 | 93.1 | < 0.001 |
Retrospective | 2 months | 2 | − 287.02 (− 322.34, − 251.71) | < 0.001 | 0 | 0.951 |
Prospective | 2 months | NA | NA | NA | NA | NA |
Overall pooling | 2 months | 2 | − 287.02 (− 322.34, − 251.71) | < 0.001 | 0 | 0.951 |
Retrospective | 3 months | 5 | − 212.22 (− 289.28, − 135.16) | < 0.001 | 97.7 | < 0.001 |
Prospective | 3 months | 11 | − 168.80 (− 202.89, − 134.71) | < 0.001 | 84.5 | < 0.001 |
Overall pooling | 3 months | 16 | − 182.70 (− 214.96, − 150.44) | < 0.001 | 94.2 | < 0.001 |
Retrospective | 6 months | 5 | − 223.29 (− 330.63, − 115.95) | < 0.001 | 97.5 | < 0.001 |
Prospective | 6 months | 11 | − 217.36 (− 278.02, − 156.71) | < 0.001 | 95.4 | < 0.001 |
Overall pooling | 6 months | 16 | − 219.53 (− 273.73, − 165.33) | < 0.001 | 96.6 | < 0.001 |
Retrospective | 9 months | NA | NA | NA | NA | NA |
Prospective | 9 months | 1 | − 113.40 (− 173.53, − 53.27) | < 0.001 | NA | NA |
Overall pooling | 9 months | 1 | − 113.40 (− 173.53, − 53.27) | < 0.001 | NA | NA |
Retrospective | 12 months | 6 | − 160.82 (− 200.14, − 121.50) | < 0.001 | 77.6 | < 0.001 |
Prospective | 12 months | 6 | − 123.89 (− 165.55, − 82.23) | < 0.001 | 79.0 | < 0.001 |
Overall pooling | 12 months | 12 | − 142.79 (− 172.87, − 112.71) | < 0.001 | 80.8 | < 0.001 |
Injection Frequency and BCVA Outcomes
Visual acuity testing scale | Follow-up time | Number of studies | Coefficient (95% CI) | P | Adjusted R2 |
---|---|---|---|---|---|
logMAR | 1 month | 9 | − 0.16 (− 2.01, 1.68) | 0.84 | 17.09% |
2 months | NA | NA | NA | NA | |
3 months | 13 | 0.01 (− 1.79, 1.81) | 0.99 | 9.61% | |
6 months | 13 | − 0.04 (− 2.66, 2.57) | 0.97 | 10.08% | |
9 months | NA | NA | NA | NA | |
12 months | 6 | − 1.19 (− 2.35, − 0.34) | 0.04 | 100% | |
ETDRS | 1 month | NA | NA | NA | NA |
2 months | NA | NA | NA | NA | |
3 months | NA | NA | NA | NA | |
6 months | 3 | 0.05 (− 0.74, 0.84) | 0.6 | 0% | |
9 months | NA | NA | NA | NA | |
12 months | 7 | 0.13 (− 0.42, 0.69) | 0.56 | 20.79% |
Injection Frequency and CMT Outcomes
Covariable | Follow-up time | Number of studies | Coefficient (95% CI) | P | Adjusted R2 |
---|---|---|---|---|---|
CMT | 1 month | 11 | − 19.81 (− 81.77, 42.14) | 0.49 | 6.04% |
2 months | NA | NA | NA | NA | |
3 months | 16 | − 15.04 (− 55.96, 25.87) | 0.44 | 4.14% | |
6 months | 16 | − 3.78 (− 65.77, 58.19) | 0.89 | 7.41% | |
9 months | NA | NA | NA | NA | |
12 months | 12 | − 20.26 (− 39.66, − 0.87) | 0.04 | 36.85% |