PMID- 27434498
OWN - NLM
STAT- MEDLINE
DCOM- 20170726
LR  - 20220316
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 11
IP  - 7
DP  - 2016
TI  - The Efficacy and Safety of Current Treatments in Diabetic Macular Edema: A 
      Systematic Review and Network Meta-Analysis.
PG  - e0159553
LID - 10.1371/journal.pone.0159553 [doi]
LID - e0159553
AB  - PURPOSE: To compare the efficacy and safety of current treatments in diabetic 
      macular edema (DME). METHODS: PubMed, Embase and CENTRAL were systematically 
      reviewed for randomized controlled trials of current treatments in DME through 
      August 2015. Data on the mean change of best-corrected visual acuity (BCVA) and 
      central macular thickness (CMT) were extracted, and adverse events (AEs) were 
      collected. RESULTS: A total of 21 trials were included in our network 
      meta-analysis. Intravitreal ranibizumab improved BCVA most significantly (OR: 
      +7.01 95%CI (2.56 to 11.39)) in 6 months and intravitreal aflibercept (+8.19 
      (5.07 to 11.96)) in 12 months. Intravitreal triamcinolone combined with LASER 
      decreased CMT most significantly (-111.34 (-254.61 to 37.93)) in 6 months and 
      intravitreal aflibercept (-110.83 (-190.25 to -35.27)) in 12 months. Compared 
      with the relatively high rate of ocular AEs in the groups with administration of 
      steroids, systematic AEs occurred more frequently in the groups with vascular 
      endothelial growth factor inhibitors involved. CONCLUSIONS: Our analysis confirms 
      that intravitreal aflibercept is most favorable with both BCVA improvement and 
      CMT decrease than other current therapies in the management of DME within 12 
      months. Vascular endothelial growth factor inhibitors for DME should be used with 
      caution due to systematic AEs. Combined intravitreal triamcinolone with LASER has 
      a stronger efficacy in decreasing CMT than the other interventions in the early 
      stage after injection. More high-quality randomized controlled trials will be 
      necessary.
FAU - Zhang, Lu
AU  - Zhang L
AD  - Department of Ophthalmology, School of Medicine, Shandong University, Jinan, 
      China.
AD  - State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of 
      Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, 
      Qingdao, China.
FAU - Wang, Wen
AU  - Wang W
AD  - Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, 
      Suzhou, China.
FAU - Gao, Yan
AU  - Gao Y
AD  - State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of 
      Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, 
      Qingdao, China.
FAU - Lan, Jie
AU  - Lan J
AD  - State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of 
      Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, 
      Qingdao, China.
FAU - Xie, Lixin
AU  - Xie L
AD  - State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of 
      Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, 
      Qingdao, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20160719
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Recombinant Fusion Proteins)
RN  - 15C2VL427D (aflibercept)
RN  - 1ZK20VI6TY (Triamcinolone)
RN  - EC 2.7.10.1 (Receptors, Vascular Endothelial Growth Factor)
RN  - ZL1R02VT79 (Ranibizumab)
SB  - IM
MH  - Diabetic Retinopathy/*drug therapy/pathology/surgery
MH  - Humans
MH  - Intravitreal Injections
MH  - Laser Therapy/methods
MH  - Macular Edema/*drug therapy/pathology/surgery
MH  - Network Meta-Analysis
MH  - Patient Safety
MH  - Randomized Controlled Trials as Topic
MH  - Ranibizumab/*therapeutic use
MH  - Receptors, Vascular Endothelial Growth Factor/*therapeutic use
MH  - Recombinant Fusion Proteins/*therapeutic use
MH  - Treatment Outcome
MH  - Triamcinolone/*therapeutic use
MH  - Visual Acuity/drug effects
PMC - PMC4951132
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2016/07/21 06:00
MHDA- 2017/07/27 06:00
PMCR- 2016/07/19
CRDT- 2016/07/20 06:00
PHST- 2016/02/01 00:00 [received]
PHST- 2016/07/04 00:00 [accepted]
PHST- 2016/07/20 06:00 [entrez]
PHST- 2016/07/21 06:00 [pubmed]
PHST- 2017/07/27 06:00 [medline]
PHST- 2016/07/19 00:00 [pmc-release]
AID - PONE-D-16-03755 [pii]
AID - 10.1371/journal.pone.0159553 [doi]
PST - epublish
SO  - PLoS One. 2016 Jul 19;11(7):e0159553. doi: 10.1371/journal.pone.0159553. 
      eCollection 2016.