Objective

To compare outcomes of cataract surgery combined with either anti-Vascular Endothelial Growth Factor (anti-VEGF) therapy or dexamethasone implant (DEX) in patients with diabetic macular oedema (DMO).

Methods

Pubmed and Embase databases were searched for studies reporting outcomes of diabetic cataract surgery combined with either anti-VEGF or DEX, with a follow-up ≥3 months. The primary outcome was the mean change in central macular thickness (CMT). Mean change in best corrected visual acuity (BCVA) was considered as a secondary outcome. The mean difference between baseline and post-treatment values (MD) with 95%-Confidence Interval (95%CI) was calculated and meta-analyses were performed.

Results

Nine-teen studies were included, 8 in the DEX group and 11 in the anti-VEGF group. A significant reduction of macular thickness was shown in the DEX group at 3 months (MD = −98.35 µm; 95% CI, −147.15/−49.54), while mean CMT change was non-significant in the anti-VEGF group (MD = −21.61 µm; 95% CI, −59.46/16.24; test of group differences, P < 0.001). At 3 months, no difference in visual gain was found between the two groups (P = 0.13).

Conclusions

In DMO patients, cataract surgery combined with DEX seems to provide better anatomical outcomes compared with cataract surgery combined with anti-VEGF therapy. However, our evidence was limited by significant heterogeneity. Randomised trials comparing these two different combined approaches are warranted.

中文翻译：

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糖尿病性黄斑水肿患者玻璃体腔内地塞米松植入与抗血管内皮生长因子治疗联合白内障手术的比较：系统回顾与荟萃分析

客观的

比较白内障手术联合抗血管内皮生长因子 (抗 VEGF) 疗法或地塞米松植入物 (DEX) 治疗糖尿病性黄斑水肿 (DMO) 患者的结果。

方法

在 Pubmed 和 Embase 数据库中搜索了报告糖尿病性白内障手术联合抗 VEGF 或 DEX 且随访时间≥3 个月的结果的研究。主要结果是中央黄斑厚度 (CMT) 的平均变化。最佳矫正视力 (BCVA) 的平均变化被视为次要结果。计算基线值和治疗后值 (MD) 之间的平均差异以及 95% 置信区间 (95%CI)，并进行荟萃分析。

结果

共纳入 19 项研究，其中 8 项在 DEX 组，11 项在抗 VEGF 组。DEX 组在 3 个月时显示黄斑厚度显着减少（MD = -98.35 µm；95% CI，-147.15/-49.54），而平均 CMT 变化在抗 VEGF 组中不显着（MD = -21.61 µm；95% CI，-59.46/16.24；组间差异检验，P  < 0.001）。3 个月时，两组之间的视力增益没有差异 ( P  = 0.13)。

结论

在 DMO 患者中，与白内障手术联合抗 VEGF 治疗相比，白内障手术联合 DEX 似乎可提供更好的解剖结果。然而，我们的证据受到显着异质性的限制。比较这两种不同组合方法的随机试验是有必要的。