PMID- 28730118
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201001
IS  - 2222-3959 (Print)
IS  - 2227-4898 (Electronic)
IS  - 2222-3959 (Linking)
VI  - 10
IP  - 7
DP  - 2017
TI  - Efficiency and safety of laser photocoagulation with or without intravitreal 
      ranibizumab for treatment of diabetic macular edema: a systematic review and 
      Meta-analysis.
PG  - 1134-1143
LID - 10.18240/ijo.2017.07.18 [doi]
AB  - AIM: To compare the therapeutic effect and safety of laser photocoagulation along 
      with intravitreal ranibizumab (IVR) versus laser therapy in treatment of diabetic 
      macular edema (DME). METHODS: Pertinent publications were identified through 
      comprehensive searches of PubMed, EMBASE, Web of Science, Cochrane Library, and 
      ClinicalTrials.gov to identify randomized clinical trials (RCTs) comparing 
      IVR+laser to laser monotherapy in patients with DME. Therapeutic effect estimates 
      were determined by weighted mean differences (WMD) of change from baseline in 
      best corrected visual acuity (BCVA) and central retinal thickness (CRT) at 6, 12, 
      or 24mo after initial treatment, and the risk ratios (RR) for the proportions of 
      patients with at least 10 letters of improvement or reduction at 12mo. Data 
      regarding major ocular and nonocular adverse events (AEs) were collected and 
      analyzed. The Review Manager 5.3.5 was used. RESULTS: Six RCTs involving 2069 
      patients with DME were selected for this Meta-analysis. The results showed that 
      IVR+laser significantly improved BCVA compared with laser at 6mo (WMD: 6.57; 95% 
      CI: 4.37-8.77; P<0.00001), 12mo (WMD: 5.46; 95% CI: 4.35-6.58; P<0.00001), and 
      24mo (WMD: 3.42; 95% CI: 0.84-5.99; P=0.009) in patients with DME. IVR+laser was 
      superior to laser in reducing CRT at 12mo from baseline with statistical 
      significance (WMD: -63.46; 95% CI: -101.19 to -25.73; P=0.001). The pooled RR 
      results showed that the proportions of patients with at least 10 letters of 
      improvement or reduction were in favor of IVR+laser arms compared with laser (RR: 
      2.13; 95% CI: 1.77-2.57; P<0.00001 and RR: 0.37; 95% CI: 0.22-0.62; P=0.0002, 
      respectively). As for AEs, the pooled results showed that a significantly higher 
      proportion of patients suffering from conjunctival hemorrhage (study eye) and 
      diabetic retinal edema (fellow eye) in IVR+laser group compared to laser group 
      (RR: 3.29; 95% CI: 1.53-7.09; P=0.002 and RR: 3.02; 95% CI: 1.24-7.32; P=0.01, 
      respectively). The incidence of other ocular and nonocular AEs considered in this 
      Meta-analysis had no statistical difference between IVR+laser and laser alone. 
      CONCLUSION: The results of our analysis show that IVR+laser has better 
      availability in functional (improving BCVA) and anatomic (reducing CRT) outcomes 
      than laser monotherapy for the treatment of DME. However, the patients who 
      received the treatment of IVR+laser may get a higher risk of suffering from 
      conjunctival hemorrhage (study eye) and diabetic retinal edema (fellow eye).
FAU - Qian, Tian-Wei
AU  - Qian TW
AD  - Department of Ophthalmology, Shanghai General Hospital; Shanghai Key Laboratory 
      of Ocular Fundus Diseases, Shanghai 200080, China.
FAU - Zhao, Meng-Ya
AU  - Zhao MY
AD  - Department of Ophthalmology, Shanghai General Hospital; Shanghai Key Laboratory 
      of Ocular Fundus Diseases, Shanghai 200080, China.
FAU - Li, Xin-Xin
AU  - Li XX
AD  - Department of Ophthalmology, Shanghai General Hospital; Shanghai Key Laboratory 
      of Ocular Fundus Diseases, Shanghai 200080, China.
FAU - Xu, Xun
AU  - Xu X
AD  - Department of Ophthalmology, Shanghai General Hospital; Shanghai Key Laboratory 
      of Ocular Fundus Diseases, Shanghai 200080, China.
LA  - eng
PT  - Journal Article
DEP - 20170718
PL  - China
TA  - Int J Ophthalmol
JT  - International journal of ophthalmology
JID - 101553860
PMC - PMC5514277
OTO - NOTNLM
OT  - Meta-analysis
OT  - anti-vascular endothelial growth factor
OT  - diabetic macular edema
OT  - laser therapy
OT  - ranibizumab
EDAT- 2017/07/22 06:00
MHDA- 2017/07/22 06:01
PMCR- 2017/07/18
CRDT- 2017/07/22 06:00
PHST- 2016/12/08 00:00 [received]
PHST- 2017/02/22 00:00 [accepted]
PHST- 2017/07/22 06:00 [entrez]
PHST- 2017/07/22 06:00 [pubmed]
PHST- 2017/07/22 06:01 [medline]
PHST- 2017/07/18 00:00 [pmc-release]
AID - ijo-10-07-1134 [pii]
AID - 10.18240/ijo.2017.07.18 [doi]
PST - epublish
SO  - Int J Ophthalmol. 2017 Jul 18;10(7):1134-1143. doi: 10.18240/ijo.2017.07.18. 
      eCollection 2017.