Efficacy and safety profile of intravitreal dexamethasone implant versus antivascular endothelial growth factor treatment: a systematic review and meta-analysis

Abstract

Abstract Purpose: To better understand the efficacy of intravitreal dexamethasone implant (Ozurdex) versus antivascular endothelial growth factor (Anti-VEGF) treatment in patients with diabetic macular edema (DME). With the emergence of novel findings over the past few years, the topic warranted a new review. Moreover, we survey the possible confounding factors while comparing these therapies. Design: A systematics review and meta-analysis Method: The study included randomized control trials and non-randomized control trials before December 2021 that compare the efficacy of Ozurdex-related treatment and Anti-VEGF treatment. We searched PubMed, Cochrane Library, and EMBASE. Risk of bias tool of Cochrane was used to assess the quality of RCTs, and Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) was used to assess the quality of Non-RCTs. Results: 2409 eyes from 30 studies were included. Regarding BCVA change, the overall result revealed no significant differences between Ozurdex and anti-VEGF therapies in patients with nonresistant DME, but Ozurdex group had significantly more VA improvement than anti-VEGF therapies in patients with resistant DME. In terms of CRT decrease, there was a significant difference between Ozurdex therapy and anti-VEGF therapy in patients with both nonresistant DME and resistant DME. The meta-regression revealed that Ozurdex therapy tended to be better than anti-VEGF therapy if the baseline CRT was more than 413 µm. Conclusions: Overall, Ozurdex therapy resulted in significantly greater VA improvement and CRT decrease than anti-VEGF therapy in the resistant DME patients. In patients with nonresistant DME, Ozurdex therapy was not inferior to anti-VEGF therapy either.