Evaluation Of The Effectiveness And Safety Of Three Anti-VEGF Drugs For Diabetic Macular Edema

Objective: This study aimed to compare the efficacy and safety of three anti-VEGF drugs,Conbercept,Ranibizumab,and Aflibercept,alone or in combination with laser and laser alone totally 7 interventions for the treatment of diabetic macular edema（DME）based on literature,and to evaluate the usage,efficacy and safety of the three agents in the real world.Methods: By collecting RCT literatures,this study compares the efficacy and safety of seven interventions on the treatment of DME that is three anti-VEGF drugs alone or in combination with laser and laser alone,with the aid of a net meta-analysis.In addition,data were prospectively collected and followed up on outpatients with DME on initial anti-VEGF agents to assess the usage,efficacy and safety of above the three anti-VEGF agents in the real world.Results: Firstly,according to a net meta-analysis,effectiveness studies showed that laser treatment alone was the least effective in all cases.In terms of reducing central retinal thickness（CRT）,Aflibercept was superior to Ranibizumab,and Conbercept was the worst at various time points,whether or not combined with laser treatment.There were no consistent results from this study in terms of improving best corrected visual acuity（BCVA）and ameliorating visual acuity.Within 12 months,the number of injections of combined laser treatment was less than that of anti VEGF alone,and the number of injections of Aflibercept was less than that of Ranibizumab.In the safety analysis,safety data related to Aflibercept were lacking for all outcome indicators.In terms of overall adverse reaction rates,anti-VEGF drugs combined with laser interventions had the highest safety profile,followed by laser alone,with anti-VEGF administration alone having the poorest safety profile.Conbercept was safer than Ranibizumab.Secondly,a total of 117 patients with 165 eyes were included in the real world study.33 patients were followed up for up to 12 months.A total of 45 patients did not continue treatment at our hospital,mainly because of poor results.81 affected eyes were treated with a combination of laser therapy.BCVA and CRT fluctuated at different time points after treatment in affected eyes,but tended to improve overall,with most of the changes in BCVA not statistically different and most of the changes in CRT statistically different.The on-time completion load treatment group had better efficacy after 3injections than the off-time completion group.The mean number of injections over 12 months was around 6 in both the combined laser treatment group and the single drug group and none of the differences were statistically significant.The incidence of adverse events was 5.76%.Most of the adverse events resolved on their own without special treatment,only 2 eyes underwent surgery and 1 eye underwent IOP-lowering treatment,and 1 patient（1 eye）abandoned further treatment with anti-VEGF drugs due to adverse events.Conclusion: All three anti-VEGF drugs are effective in treating DME either alone or in combination with laser.Aflibercept is superior in improving CRT.Anti-VEGF drugs in combination with laser therapy are better than monotherapy and have a higher safety profile.More benefit may be gained by completing loading therapy on time.