Efficacy and safety of intravitreal ranibizumab alone and combined laser therapy for the treatment of DME: a meta-analysis

Objective

To evaluate the efficacy and safety of intravitreal ranibizumab combined with laser (IVR+ Laser) and the intravitreal ranibizumab (IVR) monotherapy for the treatment of diabetic macular edema (DME).

Methods

A meta-analysis was conducted on randomized controlled trial (RCT) literature related to IVR+ Laser therapy and IVR alone for DME.Databases including Cochrane Library, PubMed, EMbase, Web of Science, SinoMed, CNKI, VIP and WanFang Data were searched from their inception to April 2022.Literature screening, data extraction, quality evaluation and cross-checking were conducted independently by two researchers according to inclusion and exclusion criteria.Then a meta-analysis was conducted using RevMan 5.4.1 software.The two therapies were compared in terms of best corrected visual acuity (BCVA), central macular thickness (CMT), mean number of injections and adverse events.

Results

Twelve RCTs involving 1 695 eyes were included in the study.Meta-analysis showed that at the end of follow-up, IVR+ Laser demonstrated better improvement in BCVA and CMT than IVR alone, and there were significant differences in the changes in BCVA and CMT between the two groups (weighted mean difference[WMD]=-0.66, 95% confidence interval[CI]: -1.11–0.21, P<0.01; WMD=-5.05, 95%CI: -9.21–0.89, P=0.02).IVR+ Laser required significantly fewer injections than IVR alone (WMD=-1.16, 95%CI: -2.07–0.25, P=0.01).There were no significant differences in the adverse events incidence between the two therapies (all at P>0.05).

Conclusions

The safety of IVR+ Laser is comparable to IVR alone, and it requires fewer injections for the treatment of DME.

Macular edema; Diabetes complications; Ranibizumab; Laser therapy; Vascular endothelial growth factors; Light coagulation; Meta-analysis