Comparative efficacy of different treatment modalities in the management of macular oedema in retinitis pigmentosa: a systematic review and network meta-analysis

Why clinicians should know about it

• Picked for Anatomy (top studies of the week, 26 July 2026): Systematic review of macular oedema treatments, retinal anatomy
• Picked for Ophthalmology (top studies of the week, 26 July 2026).

Abstract

OBJECTIVE: To compare the efficacy of current treatments for retinitis pigmentosa (RP)-associated macular oedema using network meta-analysis (NMA). METHODS AND ANALYSIS: Electronic databases were searched for studies reporting changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT). A frequentist NMA was performed and treatment hierarchies were estimated using the surface under the cumulative ranking curve. RESULTS: 12 studies were included to compare the following: oral acetazolamide 500 mg/day, oral methazolamide 50-100 mg/day, topical dorzolamide 2% three times daily, topical ketorolac 0.5% four times daily, intravenous umbilical cord mesenchymal stem cells (UCMSCs; single administration of 3×10⁶ cells), intravitreal dexamethasone implant (DEXi) 0.7 mg, intravitreal triamcinolone acetonide (IVTA) 4 mg, sub-Tenon TA (STTA) 20 mg, intravitreal bevacizumab 1.25 mg and intravitreal ranibizumab 0.5 mg. Regarding changes in BCVA at 3-4 months, oral carbonic anhydrase inhibitors (CAIs) showed greater BCVA improvement compared with anti-vascular endothelial growth factor (anti-VEGF) therapies; however, no intervention demonstrated statistically significant superiority in BCVA at 12 months. At 3-4 months, DEXi, acetazolamide, methazolamide and dorzolamide demonstrated comparable CMT reduction and outperformed anti-VEGF therapies, IVTA, STTA, intravenous UCMSC and control. By 12 months, dorzolamide (vs acetazolamide: -169.50 µm (95% CI -331.83 to -7.17) and vs methazolamide: -185.49 µm (95% CI -354.35 to -16.63)) and DEXi (vs acetazolamide: -147.00 µm (95% CI -206.58 to -87.42) and vs methazolamide: -162.99 µm (95% CI -238.56 to -87.42)) provided significantly greater CMT reduction than acetazolamide and methazolamide. CONCLUSIONS: CAIs and DEXi demonstrated the greatest long-term anatomical benefit for RP-associated macular oedema, whereas durable BCVA gains remained limited across available therapies. While oral and topical CAIs showed comparable short-term efficacy, topical dorzolamide and DEXi provided greater long-term CMT reduction than oral CAIs. Given the limited number of studies and small sample sizes, these findings should be interpreted cautiously and validated in larger randomised controlled trials.

Abstract as published, via PubMed.