Outcomes of subthreshold diode micropulse laser and anti-VEGF vs anti-VEGF monotherapy for diabetic macular edema: a meta-analysis
In brief
Adding micropulse laser reduced anti-VEGF injections by about two over a year
Across nine studies involving 535 eyes, adding micropulse laser was linked to about two fewer anti-VEGF injections over 12 months. Visual acuity favored combination treatment by roughly two letters, but that difference was not significant when analysis was limited to randomized trials; overall vision and thickness differences were below clinically important levels, and evidence certainty was low.
- Journal
- Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie (Q1)
- Published
- 26 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Amirthan Sothivannan, Victoria Leung, Bhadra U Pandya, Clara Long, Peter J Kertes, Rajeev H Muni, et al.
- PMID
- 42928376
- DOI
- 10.1007/s00417-026-07564-y
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 27 October 2026): Meta-analysis compares laser combination with anti-VEGF monotherapy for DME
Abstract
PURPOSE: To compare visual and anatomic outcomes in patients with diabetic macular edema treated with subthreshold diode micropulse laser photocoagulation (SDMLP) and anti-VEGF combination therapy versus anti-VEGF injection monotherapy. DESIGN: Meta-analysis. METHODS: We searched MEDLINE, EMBASE, and Cochrane Library between January 2005 and April 2025 for randomized controlled trials (RCTs) and observational studies comparing best-corrected visual acuity (BCVA) and central macular thickness (CMT) after SDMLP and anti-VEGF combination therapy versus anti-VEGF monotherapy. The primary outcome was change in BCVA (∆BCVA). Secondary outcomes included absolute BCVA and CMT at all time points, change in CMT (∆CMT) from baseline to all time points, and the number of anti-VEGF injections over 12 months. Outcomes were reported as a weighted mean difference (MD) with 95% confidence intervals (CI). PARTICIPANTS: Nine studies (5 RCTs, 4 cohort studies) comprising 535 eyes from 500 patients were included. RESULTS: The mean baseline BCVA was 0.56 ± 0.32 logMAR (Snellen equivalent: 20/72) and 0.56 ± 0.33 logMAR (Snellen equivalent: 20/72) in the combination and monotherapy groups, respectively. The mean baseline CMT was 431.87 ± 83.68 µm in the combination group and 411.87 ± 73.47 µm in the monotherapy group. ∆BCVA at 12 months marginally favoured combination therapy (MD [95% CI]: -0.043 [-0.086, -0.0001] logMAR (~2 Snellen letters), p=0.0497), although this difference was not statistically significant when the analysis was restricted to RCTs (-0.054 [-0.109, 0.0012] logMAR, p=0.055). Among secondary outcomes, combination therapy was superior for absolute BCVA at 12 months (MD [95% CI]: -0.062 [-0.10, -0.022] logMAR (~3 Snellen letters), p<0.001) and CMT at 12 months (MD [95% CI]: -15.3 [-20.9, -9.8] µm, p<0.001), with no significant difference in ∆CMT at 12 months (MD [95% CI]: -11.3 [-29.0, 6.4] µm, p>0.05) and significantly fewer anti-VEGF injections at 12 months (MD [95% CI]: -2.1 [-3.0, -1.1], p<0.001). GRADE analysis identified a low certainty of evidence for the primary outcome. CONCLUSIONS: In patients with DME, SDMLP and anti-VEGF combination therapy appears comparable, and possibly modestly superior to anti-VEGF monotherapy, with a reduced injection burden over 12 months. BCVA and CMT differences were below clinically important thresholds and supported by low-certainty evidence.
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.