title: The Efficacy and Safety of Current Treatments in Diabetic Macular Edema: A Systematic Review and Network Meta-Analysis.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Ophthalmology, School of Medicine, Shandong University, Jinan, China.|State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Wang
authors.affiliation: State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Gao
authors.affiliation: State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Lan
authors.affiliation: State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao, China.
authors.forename: Lixin
authors.initials: L
authors.lastname: Xie
mesh_terms: D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D058449:Intravitreal Injections; D053685:Laser Therapy / Q000379:methods; D008269:Macular Edema / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D061214:Patient Safety; D016032:Randomized Controlled Trials as Topic; D000069579:Ranibizumab / Q000627:therapeutic use*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D016896:Treatment Outcome; D014221:Triamcinolone / Q000627:therapeutic use*; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D011993:Recombinant Fusion Proteins; C533178:aflibercept; D014221:Triamcinolone; D040262:Receptors, Vascular Endothelial Growth Factor; D000069579:Ranibizumab