Purpose. The purpose of this meta-analysis was to evaluate the efficacy and safety of dexamethasone intravitreal implant (DEX) for the treatment of diabetic macular edema (DME) with retinal vein occlusion secondary to macular edema (RVO-ME). Materials and Methods. Relevant databases were searched to include randomized controlled trials (RCTs) evaluating DEX for DME and RVO-ME. The search was conducted until March 2022. Meta-analysis was performed using Rev Man 5.4.1 software after screening the literature by inclusion and exclusion criteria, extracting information, and evaluating the methodological quality of the included studies. Results. The study showed that DEX treatment of RVO-ME was associated with an improvement in best corrected visual acuity (BCVA) (MD = −9.08, 95% CI: −10.89–7.27, P < 0.00001 ) and central retinal thickness (CRT) (MD = 93.47, 95% CI: 28.55–159.39, P = 0.005 ). DEX treatment of DME was significantly better than anti-VEGF treatment in terms of CRT reduction (MD = −72.35, 95% CI: −115.0–29.69, P = 0.0009 ). The safety study showed that the risk of cataract from RVO-ME (OR = 5.06, 95% CI: 1.96 to 13.06, P = 0.0008 ) and the incidence of high intraocular pressure (OR = 6.67, 95% CI: 3.46 to 12.86, P < 0.00001 ) were significantly higher with DEX than with anti-VEGF therapy. The risk of cataract from DME (OR = 4.70, 95% CI: 2.10 to 10.54, P = 0.0002 2) was significantly higher with DEX than with anti-VEGF therapy (OR = 4.70, 95% CI: 2.10 to 10.54, P = 0.0002 ). The incidence of high IOP (OR = 13.77, 95% CI: 4.96 to 38.18, P < 0.00001 ) was significantly higher with DEX than with anti-VEGF therapy. Conclusions. In patients with DME and RVO-ME, DEX was more efficacious but slightly less safe than anti-VEGF therapy.

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BackgroundChanges in fundus signs and loss of visual acuity are an important basis for screening and treating diabetic patients with retinopathy, and conventional Western medicine is moderately effective in treating diabetic retinopathy(DR),To systematically evaluate the effectiveness and safety of Chinese herbal compounds(CHCs) in the combined treatment of diabetic retinopathy.MethodSix electronic databases, including PubMed, were searched to screen eligible literature. Randomized controlled trials of non-proliferative diabetic retinopathy(NPDR) were included, in which the control group was treated with conventional Western-based drugs or retinal laser photocoagulation, and the intervention group was treated with CHCs in combination based on the control group.The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of the literature, and the RevMan 5.4 software was used for statistical analysis.ResultsCompared with Conventional group alone,CHCs group was superior at improving clinical efficacy [RR=1.29, 95%CI=(1.23, 1.36),P&lt;0.01] and best corrected visual acuity(BCVA) [MD=0.10,95%CI=(0.09,0.12),P&lt;0.01],it was also superior at reducing the number of microangiomas [MD=-2.37, 95%CI=(-3.26, -1.49),P&lt;0.01], microangioma volume [MD=-4.72, 95%CI=(-5.14, -4.29), P&lt;0.01], hemorrhagic spots [MD=-2.05, 95%CI=(-2.51,-1.59), P&lt;0.01], hemorrhagic area [MD=-0.76, 95%CI=(-1.06, -0.47), P&lt;0.01], hard exudates [MD= -1.86, 95%CI=(-2.43, -1.28), P&lt;0.01], cotton lint spots [MD= -0.93, 95%CI= (-1.31, -0.55), P&lt;0.01], central macular thickness(CMT) [SMD=-1.52, 95%CI=(-1.85, -1.19),P&lt;0.01], Chinese medicine evidence score [SMD=-1.33,95%CI=(-1.58, -1.08),P&lt;0.01], fasting blood glucose (FBG) [SMD=-0.47, 95%CI=(-0.61,-0.33),P&lt;0.01], 2h postprandial blood glucose(2hPBG) [SMD=-0.87, 95% CI=(-1.06, -0.67), P&lt;0.01], glycosylated hemoglobin (HbAlc) [SMD=-0.76, 95%CI=(-1.16, -0.3),P&lt;0.01], total cholesterol(TC) [SMD=-0.33,95%CI=(-0.51,-0.16),P&lt;0.01],and CHCs group with less adverse events occurred [RR=0.46, 95%CI=(0.29, 0.74),P&lt;0.01].ConclusionCHCs combined with conventional medicine for NPDR has better clinical efficacy and higher safety, but the above findings need further validation in more large sample, multicenter, and low-bias RCTs due to the limitation of the quality and quantity of included literature.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022342137.

Background: In the diabetic condition, damage of Müller cells contributes to the pathogenesis of diabetic retinopathy. Methods: Primary rat retinal Müller cells (RRMC) were isolated and cultured under high glucose (50 nmol/L). The advanced glycation end products (AGEs) and sodium dithionite were applied to treat high-glucose administrated RRMC to mimic diabetic retinopathological conditions. Effect of BHTCM on diabetic retinopathological RRMC were evaluated. The expressions of aquaporin-4 (AQP4) and Kir4.1 were determined by double-labeling immunofluorescence and ELISA. Levels of vascular endothelial growth factor (VEGF), interleukin-1β (IL-1β) and pigment epithelium-derived factor (PEDF) were examined with ELISA. Lactate dehydrogenase (LDH) activity was also evaluated. Results: Retinal Muller cells were successfully isolated and identified. RRMC treated with AGEs and sodium dithionite resulted in increase of AQP4 and decrease of Kir4.1 in RRMC, increase of VEGF and IL-1β secretion, increase of LDH activity, decrease of PEDF secretion in culture medium, all of which in a dose-dependent or time-dependent manner. Post treating RRMC with AGEs and dithionite, BHTCM reversed changes in expression of AQP4 and Kir4.1 in RRMC, and reversed VEGF levels, PEDF and IL-1β secretion in culture medium. Moreover, BHTCM reversed the decrease of RRMC cell membrane integrity after AGEs and dithionite treatment. Conclusions: BHTCM protected Müller cells from diabetic damage through reducing abnormal changes of Kir4.1 and AQP4, inhibiting VEGF and IL-1β, increasing PEDF production, and maintaining cell membrane integrity. Therefore, BHTCM is a potential drug for the treatment of diabetic retinopathy, which can correct the function of Müller cells.