Meta Analysis Of The Efficacy And Safety Of Anti-VEGF Drugs And Ozurdex For The Treatment Of Macular Edema

Objective: Intend to investigate the efficacy and safety of dexamethasone implants and anti-VEGF drugs in the treatment of macular edema.Methods: A comprehensive search of Pubmed,EMbase,The Cochrane Library,Wanfang Database,China Journal full-text Database(CNKI)China Biomedical Abstract Database(CBM),and other databases was conducted.The search time limit was from 2011 to 2021,regardless of languages,and the type of search literature was a control trial.Jadad scale and risk bias assessment tools provided by Cochrane collaboration network were used to evaluate the quality of the study,and GRADEpro software was used to evaluate the parameters of each evaluation index.Finally,Review Manager5.3 software was used for Meta analysis.Results: Seven controlled trials published between 2011 and 2021 were included.A total of 1225 eyes were included,and 1099 eyes completed the test,including 682 eyes were treated with intravitreous injection of anti-VEGF(anti-VEGF group;Finally,the number of eyes in the trial was 639 cases),and 543 eyes were injected into vitreous cavity with Ozurdex(Ozurdex group;Finally,the number of eyes in the trial was 460 cases).The results of Meta analysis showed that(1)The change of best corrected visual acuity in antiVEGF group was more than that in Ozurdex group,and the difference between the two groups was statistically significant(MD=7.03 letters,95%CI(0.26,13.81),P =0.04).(2)There was no significant difference in macular fovea thickness between anti-VEGF group and Ozurdex group(MD=-9.76 μm,95%CI(-145.98,126.45),P =0.89).There was no significant difference between the two groups.(3)The change of intraocular pressure in anti-VEGF group was smaller than that in Ozurdex group(MD=-2.95 mm Hg,95%CI(-5.09,-0.81),P =0.007).The difference between the two groups was statistically significant.(4)There were more events of elevated intraocular pressure in Ozurdex group(OR=0.08,95%CI(0.01,0.52),P =0.008),and the difference between the two groups was statistically significant.(5)The number of adverse events in Ozurdex group was more than that in anti-VEGF group(OR=0.25,95%CI(0.11,0.58),P =0.001),and the difference between the two groups was statistically significant.(6)There was no significant difference in the number of severe adverse events between the anti-VEGF group and the Ozurdex group(OR=0.85,95%CI(0.19,3.80),P =0.84),and there was no significant difference between the two groups.Conclusion: Both dexamethasone implants and anti-VEGF drugs can effectively improve the visual acuity and abnormal anatomical structure of macular area in patients with macular edema.Anti-VEGF drugs are safer in the selection of drugs,and the probability of adverse events such as elevated intraocular pressure after treatment is lower.In addition,the improvement effect on visual acuity is better.However,anti-VEGF may increase the economic burden of patients because of the high injection frequency of treatment.Moreover,it may also increase the probability of adverse reactions.As a consequence,there is no obvious difference between the two drugs.Generally speaking,it is necessary to choose the appropriate treatment plan according to the specific situation.