Comparison of intravitreal aflibercept and dexamethasone implant in the treatment of macular edema associated with diabetic retinopathy or retinal vein occlusion: a Meta-analysis and systematic review

Abstract

AIM: To compare the efficacy and safety of intravitreal aflibercept with dexamethasone implant in the treatment of macular edema (ME) associated with diabetic retinopathy (DR) or retinal vein occlusion (RVO). METHODS: A comprehensive search of studies comparing dexamethasone and aflibercept in patients with ME was conducted at PubMed, Embase, and Cochrane Central Register of Controlled Trials from the beginning of library to April 16, 2021. Extracting the data including best-corrected visual acuity (BCVA), central retinal thickness (CRT), number of injections and serious adverse events (SAEs) from the final qualified articles. RevMan 5.3 software was used for Meta-analysis of the included studies. RESULTS: Totally 7 studies with 369 eyes were included. The causes of ME in the final screening study included RVO and DR. Compared with the aflibercept treatment group, the BCVA of the dexamethasone implant treatment group showed no significant difference in the follow-up for 3mo [mean difference (MD): -0.05, 95% confidence interval (CI): -0.11, 0.02; P=0.17] and 12mo (MD: -0.01, 95%CI: -0.38, 0.37; P=0.98), but it was slightly worse than the aflibercept group at 6mo (MD: 0.12, 95%CI: 0.03, 0.21; P=0.008). In terms of CRT reduction, there was no significant difference between the two groups at 3mo (MD: -28.14, 95%CI: -79.95, 23.67; P=0.29), 6mo (MD: 27.67, 95%CI: -84.89, 140.24; P=0.63), and 12mo (MD: -59.00, 95%CI: -127.37,9.37; P=0.09). However, dexamethasone implant had fewer injections, but more adverse events such as elevated intraocular pressure (IOP) and cataract. CONCLUSION: Intravitreal injection of aflibercept and dexamethasone implant can both effectively increase BCVA and reduce CRT. Compared with aflibercept, dexamethasone implant is not inferior in improving vision and reducing CRT in the initial treatment period (3mo) and long-term treatment period (12mo). Besides, it has fewer injections and more likely to cause elevated IOP and cataract.

Effect of Conbercept for macular edema secondary to branch retinal vein occlusion in different ethnic groups in Southeast Guizhou

“…At present, the treatment methods for BRVO-ME mainly include retinal laser photocoagulation and intravitreal injection (anti VEGF drugs and glucocorticoids) [19] . Intravitreal injection of anti VEGF drugs has become the main therapy of BRVO-ME including Ranibizumab [20] , Conbercept [7,[21][22][23] and A ibercept [4,[24][25][26]]. Conbercept (KH902; Chengdu Kanghong Biotech Co., China) is a recombinant fusion protein with key domains 2, 3 and 4 from VEGF receptors 1 and 2.…”

“…4.6344 million. The population of minority nationalities accounts for 79.7% of the total population, including Miao 42.09% and Dong 31.86%, which is the most densely populated area of Miao and Dong nationalities in China, and the most populous Autonomous Prefecture among ethnic minority autonomous prefectures in China.…”

Treatment of Conbercept for macular edema secondary to branch retinal vein occlusion in minority areas of Southeast Guizhou

“…At present, the treatment methods for BRVO-ME mainly include retinal laser photocoagulation and intravitreal injection (anti VEGF drugs and glucocorticoids) [19] . Intravitreal injection of anti VEGF drugs has become the main therapy of BRVO-ME including Ranibizumab [20] , Conbercept [7,[21][22][23] and A ibercept [4,[24][25][26] . Conbercept is a recombinant fusion protein of VEGF receptor and human immunoglobulin FC segment gene [21] .…”

“…BRVO can be divided into ischemic group and non-ischemic group in clinic, and the prognosis of ischemic group is poor [3] . Macular edema (ME) is the most common complication of BRVO and the most important cause of visual dysfunction [4] . Timely and effective treatment of macular edema will help to improve the vision of patients.…”

Initial response and 12-month outcomes after commencing dexamethasone or vascular endothelial growth factor inhibitors for retinal vein occlusion in the FRB registry

“…Retinal vein occlusion (RVO), the second most common retinal vascular disease 1 , may present in the form of central, hemicentral, or branch retinal vein occlusion 1 – 5 . The prevalence of RVO it is not influenced by gender and increases with advanced age, being estimated as 0.77% in people aged 30–89 years in 2015 data 6 .…”