Retinal Thickness Lower With Intravitreal Steroids for Diabetic Macular Edema

In patients with diabetic macular edema (DME), treatment with intravitreal corticosteroid injections was associated with lower retinal thickness but a higher risk of intraocular pressure-related adverse events compared with treatment with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, according to meta-analysis results published in Ophthalmology Retina.

The investigation identified no significant differences in best corrected visual acuity between the 2 treatments.

The updated meta-analysis included 14 randomized controlled trials, spanning 827 eyes, that compared the efficacy and safety of intravitreal steroids with anti-VEGF agents for DME. For inclusion, trials had to have been published between January 2005 and November 2021.

Researchers found no notable differences between intravitreal steroids and anti-VEGF agents in best corrected visual acuity outcomes at 3 months, 6 months, 12 months, or final follow-up. At 3 months, 6 months, and final follow-up, however, retinal thickness was significantly lower with intravitreal steroids. No significant difference in retinal thickness was observed at 12 months, according to study authors.

The incidence of adverse events related to intraocular pressure was higher in patients treated with intravitreal steroids than anti-VEGF injections. The incidence of other adverse events, including those related to cataracts, did not meaningfully differ between treatments.

The certainty of evidence from the trials was low to moderate, researchers noted, and heterogeneity limited the analysis.

“Our results reinforce the importance of a continual reevaluation of the role of intravitreal steroids in DME management,” wrote corresponding author Rajeev H. Muni, MD, of the University of Toronto in Canada, and coauthors. 

Reference:
Patil NS, Mihalache A, Hatamnejad A, Popovic MM, Kertes PJ, Muni RH. Intravitreal steroids compared to anti-vascular endothelial growth factor treatment for diabetic macular edema: a meta-analysis. Ophthalmol Retina. Published online October 19, 2022. doi:10.1016/j.oret.2022.10.008