A meta-analysis of clinical outcomes in diabetic macular edema
In brief
Steroid injections cut treatment burden by about four visits per year versus anti-VEGF
In a meta-analysis of 20 trials, steroids reduced central retinal thickness more than anti-VEGF (about 60 µm greater reduction) and required roughly four fewer injections annually. Anti-VEGF still outperformed laser for visual acuity and thickness, but steroids may offer a lower-frequency option for macular edema management, pending guideline updates.
- Journal
- Advances in ophthalmology practice and research (Q1)
- Published
- 10 June 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Christina N Bobrek, Ishani Kapoor, Swara M Sarvepalli, Elise Timtim, Majda Hadziahmetovic
- PMID
- 42662896
- DOI
- 10.1016/j.aopr.2026.06.001
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 31 August 2026): A meta‑analysis of clinical outcomes in diabetic macular edema
Abstract
OBJECTIVE: To compare the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF), steroid, and laser on best-corrected visual acuity (BCVA), central retinal thickness (CRT), and treatment frequency in patients with diabetic macular edema. METHODS: PubMed, EMBASE, and Web of Science were systematically searched from inception to August 2024. Mean change from baseline in BCVA (mcBCVA), mean change from baseline in CRT (mcCRT), and treatment frequency were collected using PRISMA guidelines. Statistical analysis was done on 20 studies using Review Manager 5.4.1. RESULTS: mcBCVA (mean difference (MD) = 0.14 logMAR, 95% confidence interval (CI): 0.05 to 0.23, P = 0.002) and mcCRT (MD = 38.73 μm, 95% CI: 13.39 to 64.08, P = 0.003) were significantly improved in the anti-VEGF group compared to laser. mcCRT (MD = -61.17 μm, 95% CI: -106.07 to -16.27, P = 0.008) was significantly greater in the steroid group compared to anti-VEGF. Mean number of treatments per year was significantly lower in the steroid treatment group compared to anti-VEGF (MD = -4.29, 95% CI: -4.5 to -4.09, P < 0.00001). In the anti-VEGF subgroup, mcCRT was significantly greater in the aflibercept group (MD = -37.52 μm, 95% CI: -62.97 to -12.07, P = 0.004) when compared to bevacizumab. CONCLUSIONS: These data suggest anti-VEGF treatment is more effective than laser at improving BCVA and CRT, whereas steroid treatment is more effective than anti-VEGF at improving CRT outcomes. Steroid therapy, while not currently allotted a first-line therapy in the United States, may have a more significant role in reducing treatment burden and improving macular morphology.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.