Abstract
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Aim
To compare the outcomes of intravitreal diclofenac (IVD) versus intravitreal bevacizumab (IVB) in diabetic macular edema (DME).
Methods
A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and a search of electronic information was conducted to identify all comparative studies of IVD versus IVB in DME. Best-corrected visual acuity (BCVA), central macular thickness (CMT) and paracentral or parafoveal macular thickness were primary outcome measures. Secondary outcome measures included intraocular pressure (IOP) changes, macular leakage and injection-related complication. Fixed effects modelling was used for the analysis.
Results
Three studies enrolling 149 patients were identified. There was no significant difference between the IVD and IVB groups in BCVA at 4-6 weeks (Mean Difference [MD] = 0.01, P = 0.87) and 3 months (MD = 0.01, P = 0.68) postoperatively. There was no significant difference between the two groups in CMT at 4-6 weeks (MD = 13.53, P = 0.40) and 3 months (MD = 21.85, P = 0.30) postoperatively. Similarly, there was no statistically significant difference between the two groups in the change in paracentral macular thickness. For secondary outcomes, no statistically significant difference between the IVD and IVB groups in IOP changes, macular leakage as well as injection-related complication.
Conclusions
Intravitreal diclofenac is an alternative to bevacizumab in the treatment of DME as they both produced similar postoperative changes in BCVA, CMT, paracentral macular thickness and IOP.
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