Intravitreal anti-vascular endothelial growth factor, laser photocoagulation, or combined therapy for diabetic macular edema: A systematic review and network meta-analysis

Chen, Jiasheng; Wang, Haowei; Qiu, Weiqiang

doi:10.3389/fendo.2023.1096105

Cited by 9 publications

(2 citation statements)

References 46 publications

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“…DME is a common complication of diabetic retinopathy and a leading cause of vision loss. Its current first-line treatment involves IV injections of anti-VEGF agents (Ranibizumab, Aflibercept, and Bevacizumab), which have shown significant efficacy in improving vision [ 101 ]. However, these treatments have limitations, including the need for frequent injections and potential AEs related to the IV application.…”

Section: Suprachoroidal Injection In Ocular Diseasesmentioning

confidence: 99%

Suprachoroidal Injection: A Novel Approach for Targeted Drug Delivery

Wu,

Fujioka,

Gholamian

et al. 2023

Pharmaceuticals

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Treating posterior segment and retinal diseases poses challenges due to the complex structures in the eye that act as robust barriers, limiting medication delivery and bioavailability. This necessitates frequent dosing, typically via eye drops or intravitreal injections, to manage diseases, often leading to side effects with long-term use. Suprachoroidal injection is a novel approach for targeted drug delivery to the posterior segment. The suprachoroidal space is the region between the sclera and the choroid and provides a potential route for minimally invasive medication delivery. Through a more targeted delivery to the posterior segment, this method offers advantages over other routes of administration, such as higher drug concentrations, increased bioavailability, and prolonged duration of action. Additionally, this approach minimizes the risk of corticosteroid-related adverse events such as cataracts and intraocular pressure elevation via compartmentalization. This review focuses on preclinical and clinical studies published between 2019 and 2023, highlighting the potential of suprachoroidal injection in treating a variety of posterior segment diseases. However, to fully harness its potential, more research is needed to address current challenges and limitations, such as the need for technological advancements, refinement of injection techniques, and consideration of cost and accessibility factors. Future studies exploring its use in conjunction with biotech products, gene therapies, and cell-based therapies can lead to personalized treatments that can revolutionize the field of ophthalmology.

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Section: Suprachoroidal Injection In Ocular Diseasesmentioning

confidence: 99%

Suprachoroidal Injection: A Novel Approach for Targeted Drug Delivery

Wu,

Fujioka,

Gholamian

et al. 2023

Pharmaceuticals

View full text Add to dashboard Cite

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“…In comparison, laser treatment is generally considered more cost-effective than pharmacotherapy, including both anti-VEGF and steroid treatments [ 94 ]. Laser treatment also offers the advantage of a longer-lasting effect compared to anti-VEGF therapy [ 95 ]. Moreover, several studies have demonstrated that the combination of laser photocoagulation with anti-VEGF treatment has the potential to reduce the frequency of injections ( Table 2 ) [ 96 ].…”

Section: The Current Role Of Laser Photocoagulation In the Era Of Int...mentioning

confidence: 99%

The Role of Laser Photocoagulation in Treating Diabetic Macular Edema in the Era of Intravitreal Drug Administration: A Descriptive Review

et al. 2023

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Background and Objectives: This study aimed to elucidate the role of laser photocoagulation therapy in the treatment of diabetic macular edema (DME) as an alternative to, or in conjunction with, the first-line treatment, anti-vascular endothelial growth factor (VEGF). Materials and Methods: A comprehensive literature search to identify studies that evaluated the efficacy of laser photocoagulation therapy in the management of DME was performed. The relevant findings of the efficacy of focal/grid laser therapy from data in randomized, controlled trials were synthesized, and the potential of new laser technologies, such as navigated laser systems, pattern scan lasers, and subthreshold lasers, was explored. The usefulness of multimodal imaging-guided laser therapy was also evaluated, with a focus on the potential contribution to anti-VEGF therapy. Results: Focal laser photocoagulation targeting microaneurysms remains an effective therapeutic approach to chronic refractory edema, despite the widespread use of anti-VEGF therapy. To achieve the best possible treatment outcomes, precise identification of microaneurysms is essential. This requires the use of multimodal imaging-guided, highly accurate, minimally invasive coagulation techniques. Subthreshold laser therapy can also reduce the frequency of anti-VEGF injections and minimize treatment burden. Conclusions: Further studies are needed to determine the optimal timing and settings for laser photocoagulation therapy and the potential of new laser technologies in the management of DME. Nevertheless, laser photocoagulation therapy plays an important role in the management of DME, in conjunction with anti-VEGF therapy.

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Efficacy of anti-VEGF monotherapy versus anti-VEGF therapy with subthreshold micropulse laser (SML) in the management of diabetic macular oedema (DMO): a systematic review and meta-analysis

Wijeweera,

Ni,

Petocz

et al. 2024

Graefes Arch Clin Exp Ophthalmol

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Background Intravitreal injection anti-vascular endothelial growth factor (IVI anti-VEGF) therapy serves as the primary treatment for centre involving diabetic macular oedema (DMO). Conventional laser therapy (CLT) adjunct has proven beneficial; however, it is not widely used due to significant risks of retinal scarring. Subthreshold micropulse laser (SML) therapy has, however, emerged as a comparable alternative to combination therapy, offering a distinct advantage by mitigating the risk of retinal scarring. Methods A search of six databases was conducted. A meta-analysis of mean differences was performed including subgroup analyses where appropriate. Primary outcome was the number of injections at 12–14 months; secondary outcomes were changes in central macular thickness (CMT) and best corrected visual acuity (BCVA) at 6–8 months and 12–14 months. Results A total of ten papers including six randomised clinical trials and four retrospective clinical studies were included in our study, capturing 563 eyes of 478 patients. Overall, the risk of bias was moderate for these studies. Significantly fewer anti-VEGF therapy injections were administered in the combination therapy versus anti-VEGF monotherapy patients at 12–14 months who had poor visual acuity (6/18 Snellen or worse) at baseline, mean difference − 2.25 (95% CI; − 3.35, − 1.15; p < 0.05). Combination therapy was not associated with significantly fewer intravitreal injections in patients with a higher visual acuity (6/15 Snellen or better) at baseline. Our analysis also showed significant improvements to both BCVA and CMT were reached at 6 − 8 month post-baseline at the 95% confidence intervals: − 1.13 (− 2.09, − 0.16) and − 4.04 (− 7.59, − 0.50). These improvements remained statistically significant at 12–14 months: − 0.94 (− 1.67, − 0.20) and − 1.92 (− 3.52, − 0.32) respectively with combination therapy. Conclusion Our findings demonstrate that combination therapy (SML + IVI anti-VEGF) is associated with fewer intravitreal injections. We report a better BCVA and a reduction in CMT at 6 and 12 months from baseline with combination treatment compared to the IVI anti-VEGF monotherapy comparator. SML is a proven non-scarring cost-effective therapy for DMO that should be readily available in the medical retinal therapy as it may reduce the burden of care.

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Intravitreal anti-vascular endothelial growth factor, laser photocoagulation, or combined therapy for diabetic macular edema: A systematic review and network meta-analysis

Cited by 9 publications

References 46 publications

Suprachoroidal Injection: A Novel Approach for Targeted Drug Delivery

Suprachoroidal Injection: A Novel Approach for Targeted Drug Delivery

The Role of Laser Photocoagulation in Treating Diabetic Macular Edema in the Era of Intravitreal Drug Administration: A Descriptive Review

Efficacy of anti-VEGF monotherapy versus anti-VEGF therapy with subthreshold micropulse laser (SML) in the management of diabetic macular oedema (DMO): a systematic review and meta-analysis

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