The Efficacy And Safety Of Drug Therapy,Laser Therapy And Combined Therapy For Diabetic Macular Edema:A Meta-analysis

Objective: To evaluate the efficacy and safety of drug therapy,laser therapy and Combined therapy in the treatment of diabetic macular edema.Methods: Published randomized controlled trials(RCTs) concerning intravitreal ranibizumab(IVR), intravitreal triamcinolone acetonide(IVTA) and prospective laser photocoagulation therapy for diabetic macular edema were retrieved from databases the Cochrane library, Pubmed, Embase, CNKI, and SCI up to March 2016.Use the authority of the quality evaluation criteria provided by Cochrane network, the methodology of quality assessment, to fully extract and analyze the effective data by Revman 5.0 software.Results: Finally 12 independent RCTs were identified and used for comparing IVR or with Laser and Laser,IVTA or with Laser and Laser. The meta analysis showed that:1.the differences of the BCVA change: IVR(270 eyes)significantly improved compared with Laser(249 eyes)(P<0.00001);there were no significantly different between IVTA(77 eyes)and Laser(88 eyes)(P=0.25); there were no significantly different between IVR(323 eyes) and IVR + Laser(320 eyes), IVTA(29 eyes) and IVTA + Laser(39 eyes)(P=0.47 and 0.38 respectively); IVR + Laser showed better effect than Laser(P<0.00001); IVTA + Laser was greater than Laser(P<0.00001). 2. the differences of the CRT change: IVR showed significant reducement compared with Laser(P<0.00001);IVTA showed better effect than Laser at 1 month but no significantly different between the two groups at 6 month(P<0.00001,P=0.52 respectively); there were no significantly different between IVR(323 eyes) and IVR+ Laser(320 eyes), IVTA(29 eyes) and IVTA + Laser(39 eyes)(P=0.07 and 0.62 respectively); IVR + Laser showed better effect than Laser(P<0.00001); IVTA + Laser significantly improved the CRT at 1 month, compared with Laser(P<0.00001),but there were no significantly different between the two groups at 6 months(P=0.09). 3.Adverse events between IVR and IVR + Laser(P = 1.01), Laser and IVR + Laser(P = 0.91),there were no statistically significant difference;IVR showed higher risk rate than Laser(P<0.01);In the early stage, the group of IVTA as intervention measures were more likely to appear high intraocular pressure, glaucoma, cataract and other adverse reactions, and the difference is statistically significant(P < 0.01), but in advanced treatment there was no significantly difference between the groups.Conclusion: For diabetic macular edema, ranibizumab can be considered as first choice, triamcinolone acetonide still has great study field as its limitations and poor long-term curative effect, While anti-VEGF agents appear to be superior over other available therapies for DME, intraocular steroids may be considered in a certain subset of patients with pseudophakia, persistent suboptimal response to anti-VEGF agents, or systemic vascular comorbidities that preclude the use of anti-VEGF agents.;As to combined therapy, on-demand laser treatment based on drug therapy can increase more efficacy and safety than laser alone.