Efficacy and safety of single-dose dexamethasone implantation for patients with persistent diabetic macular edema: a systematic review and meta-analysis

Abstract

This meta-analysis was conducted to evaluate the efficacy and safety of single-dose dexamethasone implantation for treating persistent DME (diabetic macular edema) refractory to anti-VEGF (anti-vascular endothelial growth factor) drugs over a period of 6 months. All related clinical trials were reviewed by searching electronic databases of PubMed, Medline, Web of Science, Cochrane Library, and EMBASE. The primary outcome parameters were best-corrected visual acuity (BCVA) and central macular thickness (CMT). We performed this meta-analysis by using Stata15.0. Ten clinical trials involving 362 eyes from 328 patients were eligible in the final analysis. After single-dose dexamethasone implantation, there was a significant improvement in BCVA from baseline to 1, 3, and 6 months with an average increase of\u2009−\u20090.15 logMAR (p\u2009<\u20090.001),\u2009−\u20090.14 logMAR (p\u2009<\u20090.001), and\u2009−\u20090.07 logMAR (p\u2009=\u20090.004), respectively. Further, mean CMT decreased significantly with an average reduction of 249.18 μm (p\u2009<\u20090.001), 217.66 μm (p\u2009<\u20090.001), and 91.56 μm (p\u2009<\u20090.001) at months 1, 3, and 6, respectively. Our results indicate that switching to a dexamethasone implant could achieve significant anatomical and functional improvement among patients with refractory DME. Clinicians should be aware of this treatment option in refractory DME.