| ObjectiveTo evaluate the efficacy of photocoagulation and intravitreal agents such as aflibercept,ranibizumab,bevacizumab,dexamethasone and triamcinolone monotherapy or combined therapy in diabetic retinopathy and their risk of developing vascular complications.MethodsThe search strategies were based on the PICOS principle.We searched Pub Med,Cochrane Library,Embase from inception to December,2020,then identified randomized controlled trials meeting inclusion and exclusion criterias.We extracted the basic information and outcomes,assessed the quality of included studies according to Cochrane risk of bias tool.Network meta-analysis was performed by Stata14.0,continuous variables were calculated by mean difference(MD)or relative risk(RR)and 95% confidence interval(95%CI).ResultsA total of 36 randomized clinical trials(RCTs)were included in our network meta-analysis,involving 8446 eyes with diabetic retinopathy.Among these,27 RCTs were included in the study of comparing efficacy of included interventions to improve central macular edema.19 RCTs were included in the study of comparing efficacy of included interventions to improve visual acuity.11 RCTs were included in the study of evaluating the risk of included interventions to develop vascular complications(VCs).Network meta-analysis shows as followed:According to the results of SUCRA,the first of the 13 interventions included in the study comparing the efficacy of interventions to improve macular edema is intravitreal triamcinolone combined with laser therapy(SUCRA=84.5%,mean rank=2.9).The first of the 12 interventions included in the study comparing the efficacy of interventions to improve visual acuity is intravitreal bevacizumab monotherapy(SUCRA=95.8%,mean rank=1.5).In the study comparing the risk of vascular complications after each intervention,the first of the 9 interventions included was laser photocoagulation(SUCRA=24.2%,mean rank=7.1).ConclusionConcerned to the treatments of diabetic retinopathy:1.Laser photocoagulation may be preferable in improving macular edema,but gets little advantage in improving visual acuity over other therapies.Meanwhile,the study reveals that laser treatment may bring about higher risk of vascular complications than other treatments.2.Anti-vascular epithelial growth factor agents(aflibercept,ranibizumab,bevacizumab)monotherapy may get advantage over other therapies monotherapy in improving visual acuity,and it demonstrates that the risk of developing vascular complications were not distinct between aflibercept or bevacizumab and sham.3.Intravitreal dexamethasone or triamcinolone monotherapy does not get an edge over other treatments both in improving macular edema and visual acuity.4.In combination therapy,intravitreal triamcinolone combined with laser may be preferable in decreasing retinal thickness,but gets little advantage in increasing visual acuity,and it may have low risk of developing vascular events as sham.Intravitreal ranibizumab combined with laser or intravitreal triamcinolone therapy may be not superior to intravitreal ranibizumab monotherapy in improving macular edema and visual acuity. |
