title: Ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To evaluate the relative efficacy of ranibizumab (RBZ) monotherapy or combined with laser (RBZ + Laser) versus laser monotherapy for the treatment of diabetic macular edema (DME).
  
  
  METHODS
  A comprehensive literature search using PUBMED, ClinicalTrials.gov, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing RBZ or RBZ + Laser to laser monotherapy in patients with DME. Efficacy estimates were determined by comparing weighted mean differences (WMD) in the change of best corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline, and the risk ratios (RR) for the proportions of patients with at least 15 letters change from baseline. Safety analysis estimated the RR of cardiac disorders at 6 to 12 months in RBZ therapy vs. laser monotherapy. Statistical analysis was performed using the RevMan 5.1 software.
  
  
  RESULTS
  Seven RCTs were selected for this meta-analysis, including 1749 patients (394 patients in the RBZ group, 642 patients in the RBZ + Laser group, and 713 patients in the laser group). RBZ and RBZ + Laser were superior to laser monotherapy in the mean change of BCVA and CMT from baseline (WMD = 5.65, 95% confidence interval (CI), 4.44-6.87, P<0.00001; WMD  = 5.02, 95% CI, 3.83-6.20, P<0.00001, and WMD  = -57.91, 95% CI, -77.62 to -38.20, P<0.00001; WMD  = -56.63, 95% CI, -104.81 to -8.44, P = 0.02, respectively). The pooled RR comparing the proportions of patients with at least 15 letters improvement or deterioration were also in favor of RBZ and RBZ + Laser (RR = 2.94, 95% CI, 1.82-4.77, P<0.00001; RR = 2.04, 95% CI, 1.50-2.78, P<0.00001, and RR = 0.21, 95% CI, 0.06-0.71, P = 0.01; RR = 0.52, 95% CI, 0.29-0.95, P = 0.03, respectively). There were no significant differences between RBZ and RBZ + Laser for any of the parameters. There were no difference in the safety profile between RBZ and laser.
  
  
  CONCLUSIONS
  RBZ and RBZ + Laser had better visual and anatomic outcomes than laser monotherapy in the treatment of DME. RBZ + Laser seemed to be equivalent to RBZ.
authors.affiliation: Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang, PR China.
authors.forename: Guohai
authors.initials: G
authors.lastname: Chen
authors.affiliation: Xiamen Eye Center of Xiamen University, Xiamen, Fujian, PR China.
authors.forename: Wensheng
authors.initials: W
authors.lastname: Li
authors.affiliation: The Roskamp Institute, Sarasota, Florida, United States of America; Department of Ophthalmology, University of South Florida, Tampa, Florida, United States of America.
authors.forename: Radouil
authors.initials: R
authors.lastname: Tzekov
authors.affiliation: Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang, PR China.
authors.forename: Fangzheng
authors.initials: F
authors.lastname: Jiang
authors.affiliation: Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang, PR China.
authors.forename: Sihong
authors.initials: S
authors.lastname: Mao
authors.affiliation: Department of Ophthalmology, Quzhou People's Hospital, Quzhou, Zhejiang, PR China.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Tong
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008269:Macular Edema / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D000069579:Ranibizumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069579:Ranibizumab