Safety and Efficacy of Dexamethasone Intravitreal Implant in Secondary Macular Edema Patients: A Meta-analysis
ZHAO Zi-nan1, LÜ Jun-ling1, TIAN Chao2, LI Chao1, LI Ting1, LI Ke-xin1, XUE Wei1, TAN Ling1*
1. Department of Pharmacy, National Center of Gerontology, Clinical Trial Center, Beijing Hospital, Beijing 100730, China; 2. Department of Pharmacy, Beijing Children's Hospital Affiliated to The Capital Medical University,National Center for Children's Health, Beijing 100045, China
Abstract：OBJECTIVE To systematically review the safety and efficacy of dexamethasone intravitreal implant (DEX) in secondary macular edema (ME) patients. METHODS Multiple databases were searched electronically for randomized controlled trials (RCTs) of DEX in secondary ME patients up to April 2019. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then Meta-analysis was performed using Rev Man 5.3 software. RESULTS A total of nine randomized controlled trials involving 1 530 patients were included. There were 737 patients in the experimental group and 793 patients in the control group. DEX was retrieved. Anti-vascular endothelial growth factor (anti-VEGF) or sham injection were used to treat the patients in the control group. The efficacy analysis results showed that the improvement rate of best corrected visual acuity (BCVA) in DEX group was significant higher than the control group in retinal vein occlusion (RVO) patients [MD=-10.59, 95%CI: -13.96--7.23,P=0.01]. The CST/CRT decrease in DEX was significant lower than control group in diabetic macular edema(DME) patients [MD=-63.60, 95%CI: -114.83--12.37,P=0.01], but higher than the control group in RVO [MD=-114.89, 95%CI: -48.68--181.09,P=0.00]. The safty analysis results showed that the incidence of serious adverse events (SAEs) in DEX was significant higher than control group [9.36% (28/299) : 5.23%(19/363), RR=1.94, 95%CI: 1.05-3.59, P=0.04]in RVO. The cataractin DEX was significant higher in RVO [4.87%(22/452) : 0.97% (5/513), RR=5.06, 95%CI: 1.96-13.06, P=0.00] than the control group. CONCLUSION DEX has better efficacy than anti-VEGF in DME patients. DEX is similar in efficacy but inferior in safety to anti-VEGF in patients with ME secondary to RVO.
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2020, Vol. 55 
