Efficacy and safety of dexamethasone versus intravitreal aflibercept implants for macular edema: a systematic review and meta-analysis
Abstract Background Macular edema (ME) is a prevalent complication of diabetic retinopathy (DR) and retinal vein occlusion (RVO) that contributes significantly to vision impairment worldwide. This condition is primarily driven by elevated vascular endothelial growth factor (VEGF) and pro-inflammator...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-04-01
|
| Series: | European Journal of Medical Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40001-025-02404-x |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850181999912812544 |
|---|---|
| author | Khaled Moghib Trisha Shivashankar Abdallah Abunamoos Al Hasan Mia Izere Salomon Thoria Ghanm Ammar Salah Mohamed A. Aldemerdash Mona I. Elshamy |
| author_facet | Khaled Moghib Trisha Shivashankar Abdallah Abunamoos Al Hasan Mia Izere Salomon Thoria Ghanm Ammar Salah Mohamed A. Aldemerdash Mona I. Elshamy |
| author_sort | Khaled Moghib |
| collection | DOAJ |
| description | Abstract Background Macular edema (ME) is a prevalent complication of diabetic retinopathy (DR) and retinal vein occlusion (RVO) that contributes significantly to vision impairment worldwide. This condition is primarily driven by elevated vascular endothelial growth factor (VEGF) and pro-inflammatory cytokines, resulting in the use of anti-VEGF agents such as aflibercept and corticosteroids such as dexamethasone implants. However, evidence comparing the clinical efficacy and safety of these two modalities remains limited. Objectives This systematic review and meta-analysis aimed to compare the safety and efficacy of intravitreal aflibercept injections and dexamethasone implants in ME associated with DR and RVO. Method The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD42024577212). A comprehensive search of the PubMed, Cochrane, Web of Science, and Scopus databases was performed until August 30, 2024. Nine studies, involving 572 eyes, were included in the analysis. Key outcomes assessed included Best-Corrected Visual Acuity (BCVA), Central Retinal Thickness (CRT), and Intraocular Pressure (IOP). A random-effects model was applied to the pooled effect size calculations, and heterogeneity was addressed using sensitivity analyses. Results Both treatments showed comparable efficacy in improving BCVA and reducing CRT across follow-up intervals. At 3 months, dexamethasone implants demonstrated statistically significant superiority in BCVA improvement (MD = 1.18, 95% CI [0.89, 1.47], P < 0.001) and CRT reduction (MD = − 62.45 µm, 95% CI [− 85.67, − 39.22], P < 0.001) compared to aflibercept. Similarly, at 12 months, dexamethasone implants maintained greater efficacy in CRT reduction (MD = − 58.73 µm, 95% CI [− 78.12, − 39.34], P < 0.001). However, dexamethasone implants were associated with an increased IOP at 3 and 6 months (MD = 1.04 mmHg, 95% CI [0.56, 1.52], P < 0.001). No significant differences in IOP were observed between treatments at 12 months. Conclusion Intravitreal aflibercept injections and dexamethasone implants are effective modalities for the management of ME, with each presenting distinct advantages. Dexamethasone implants minimize the frequency of treatment, while achieving superior outcomes in terms of BCVA and CRT. However, they are also associated with a heightened risk of IOP elevation and cataract formation. Conversely, aflibercept requires more frequent administration, which may result in logistical and financial challenges for patients and health care providers. Therefore, personalized treatment strategies should consider disease severity, comorbidities, and individual preferences. Future research should prioritize patient-centered outcomes, emphasizing quality of life and treatment costs while also investigating condition-specific responses to these therapeutic interventions. |
| format | Article |
| id | doaj-art-b81becf6d5c34464bbdbc81f5fc1c0fa |
| institution | OA Journals |
| issn | 2047-783X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | European Journal of Medical Research |
| spelling | doaj-art-b81becf6d5c34464bbdbc81f5fc1c0fa2025-08-20T02:17:46ZengBMCEuropean Journal of Medical Research2047-783X2025-04-0130112010.1186/s40001-025-02404-xEfficacy and safety of dexamethasone versus intravitreal aflibercept implants for macular edema: a systematic review and meta-analysisKhaled Moghib0Trisha Shivashankar1Abdallah Abunamoos2Al Hasan Mia3Izere Salomon4Thoria Ghanm5Ammar Salah6Mohamed A. Aldemerdash7Mona I. Elshamy8Faculty of Medicine, Cairo UniversityBharati Vidyapeeth Medical CollegeSchool of Medicine, The University of JordanDhaka Medical CollegeCollege of Medicine and Health Sciences, University of RwandaFaculty of Medicine, Mansoura UniversityFaculty of Medicine, Al_azhar AsuitFaculty of Medicine, Sohag UniversityFaculty of Medicine, Ain Shams UniversityAbstract Background Macular edema (ME) is a prevalent complication of diabetic retinopathy (DR) and retinal vein occlusion (RVO) that contributes significantly to vision impairment worldwide. This condition is primarily driven by elevated vascular endothelial growth factor (VEGF) and pro-inflammatory cytokines, resulting in the use of anti-VEGF agents such as aflibercept and corticosteroids such as dexamethasone implants. However, evidence comparing the clinical efficacy and safety of these two modalities remains limited. Objectives This systematic review and meta-analysis aimed to compare the safety and efficacy of intravitreal aflibercept injections and dexamethasone implants in ME associated with DR and RVO. Method The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD42024577212). A comprehensive search of the PubMed, Cochrane, Web of Science, and Scopus databases was performed until August 30, 2024. Nine studies, involving 572 eyes, were included in the analysis. Key outcomes assessed included Best-Corrected Visual Acuity (BCVA), Central Retinal Thickness (CRT), and Intraocular Pressure (IOP). A random-effects model was applied to the pooled effect size calculations, and heterogeneity was addressed using sensitivity analyses. Results Both treatments showed comparable efficacy in improving BCVA and reducing CRT across follow-up intervals. At 3 months, dexamethasone implants demonstrated statistically significant superiority in BCVA improvement (MD = 1.18, 95% CI [0.89, 1.47], P < 0.001) and CRT reduction (MD = − 62.45 µm, 95% CI [− 85.67, − 39.22], P < 0.001) compared to aflibercept. Similarly, at 12 months, dexamethasone implants maintained greater efficacy in CRT reduction (MD = − 58.73 µm, 95% CI [− 78.12, − 39.34], P < 0.001). However, dexamethasone implants were associated with an increased IOP at 3 and 6 months (MD = 1.04 mmHg, 95% CI [0.56, 1.52], P < 0.001). No significant differences in IOP were observed between treatments at 12 months. Conclusion Intravitreal aflibercept injections and dexamethasone implants are effective modalities for the management of ME, with each presenting distinct advantages. Dexamethasone implants minimize the frequency of treatment, while achieving superior outcomes in terms of BCVA and CRT. However, they are also associated with a heightened risk of IOP elevation and cataract formation. Conversely, aflibercept requires more frequent administration, which may result in logistical and financial challenges for patients and health care providers. Therefore, personalized treatment strategies should consider disease severity, comorbidities, and individual preferences. Future research should prioritize patient-centered outcomes, emphasizing quality of life and treatment costs while also investigating condition-specific responses to these therapeutic interventions.https://doi.org/10.1186/s40001-025-02404-xMacular edemaDiabetic macular edema (DME)Diabetic retinopathy (DR)Retinal vein occlusion (RVO)Intravitreal afliberceptDexamethasone implants |
| spellingShingle | Khaled Moghib Trisha Shivashankar Abdallah Abunamoos Al Hasan Mia Izere Salomon Thoria Ghanm Ammar Salah Mohamed A. Aldemerdash Mona I. Elshamy Efficacy and safety of dexamethasone versus intravitreal aflibercept implants for macular edema: a systematic review and meta-analysis European Journal of Medical Research Macular edema Diabetic macular edema (DME) Diabetic retinopathy (DR) Retinal vein occlusion (RVO) Intravitreal aflibercept Dexamethasone implants |
| title | Efficacy and safety of dexamethasone versus intravitreal aflibercept implants for macular edema: a systematic review and meta-analysis |
| title_full | Efficacy and safety of dexamethasone versus intravitreal aflibercept implants for macular edema: a systematic review and meta-analysis |
| title_fullStr | Efficacy and safety of dexamethasone versus intravitreal aflibercept implants for macular edema: a systematic review and meta-analysis |
| title_full_unstemmed | Efficacy and safety of dexamethasone versus intravitreal aflibercept implants for macular edema: a systematic review and meta-analysis |
| title_short | Efficacy and safety of dexamethasone versus intravitreal aflibercept implants for macular edema: a systematic review and meta-analysis |
| title_sort | efficacy and safety of dexamethasone versus intravitreal aflibercept implants for macular edema a systematic review and meta analysis |
| topic | Macular edema Diabetic macular edema (DME) Diabetic retinopathy (DR) Retinal vein occlusion (RVO) Intravitreal aflibercept Dexamethasone implants |
| url | https://doi.org/10.1186/s40001-025-02404-x |
| work_keys_str_mv | AT khaledmoghib efficacyandsafetyofdexamethasoneversusintravitrealafliberceptimplantsformacularedemaasystematicreviewandmetaanalysis AT trishashivashankar efficacyandsafetyofdexamethasoneversusintravitrealafliberceptimplantsformacularedemaasystematicreviewandmetaanalysis AT abdallahabunamoos efficacyandsafetyofdexamethasoneversusintravitrealafliberceptimplantsformacularedemaasystematicreviewandmetaanalysis AT alhasanmia efficacyandsafetyofdexamethasoneversusintravitrealafliberceptimplantsformacularedemaasystematicreviewandmetaanalysis AT izeresalomon efficacyandsafetyofdexamethasoneversusintravitrealafliberceptimplantsformacularedemaasystematicreviewandmetaanalysis AT thoriaghanm efficacyandsafetyofdexamethasoneversusintravitrealafliberceptimplantsformacularedemaasystematicreviewandmetaanalysis AT ammarsalah efficacyandsafetyofdexamethasoneversusintravitrealafliberceptimplantsformacularedemaasystematicreviewandmetaanalysis AT mohamedaaldemerdash efficacyandsafetyofdexamethasoneversusintravitrealafliberceptimplantsformacularedemaasystematicreviewandmetaanalysis AT monaielshamy efficacyandsafetyofdexamethasoneversusintravitrealafliberceptimplantsformacularedemaasystematicreviewandmetaanalysis |