IVTA for diabetic macular edema and macular edema secondary to retinal vein occlusion: a meta-analysis
Reviewed by Sofia Rokerya

This meta-analysis aimed to compare the safety and efficacy of different doses of intravitreal triamcinolone acetonide (IVTA) for diabetic macular oedema (DME) and macular oedema (ME) secondary to retinal vein occlusion (RVO). A systematic literature search for randomised controlled trials (RCTs) was conducted using the Cochrane Library, Ovid MEDLINE, and EMBASE from January 2005 to May 2022. Studies reporting on patients with DME or ME secondary to RVO that received treatment with different doses of IVTA were included. A random-effects meta-analysis was performed. Cochrane’s Risk of Bias Tool 2 was used to assess the risk of bias, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines were used to assess certainty of evidence. Five RCTs reporting on 1041 eyes were included in this meta-analysis. The primary outcome was change in best corrected visual acuity (BCVA) from baseline. Secondary outcomes were change in retinal thickness from baseline and adverse events, including the incidence of subconjunctival haemorrhage, vitreous haemorrhage, increased intraocular pressure (IOP), ocular hypertension or glaucoma, glaucoma surgery, cataract, cataract surgery, vitreous floaters, endophthalmitis, retinal detachment, and eye pain. It was noted that eyes with ME secondary to RVO, high-dose (4 mg) IVTA achieved a significantly better change in BCVA (WMD = -4.75 ETDRS letters, 95% CI = [-7.73, -1.78], p=0.002) and reduction in retinal thickness (WMD = -93.02μm, 95% CI = [-153.23, -32.82], p=0.002) at months 4–6 compared to low-dose (1–2 mg) IVTA. However, high-dose IVTA had a higher risk of IOP-related adverse events (RR = 2.99, 95% CI = [1.05, 8.50], p=0.04) and cataract surgery (RR = 5.67, 95% CI = [3.09, 10.41], p=0.00001) than low-dose IVTA in eyes with ME secondary to RVO. The efficacy and safety differences in high-dose and low-dose IVTA were not observed in DME eyes. Limitations: (1) Low sample sizes across comparisons, resulting in an overall low certainty of evidence, inconsistent reporting of outcomes across RCTs and heterogeneity associated with certain outcomes may limit generalisation of conclusions. (2) Some patients received previous laser therapy – this may have influenced baseline differences and outcomes. (3) Lens status may have been a confounder for visual acuity, as most included studies did not present efficacy outcomes stratified by lens status. (4) Included studies were at least eight years old, which may not reflect current management practices in their entirety. (5) Mode of visual acuity measurements was variable across included studies. (6) Studies differed in baseline characteristics (such as BCVA, which could not be adjusted for) in the analysis and may have had an impact on mean change in BCVA from baseline.

Intravitreal triamcinolone acetonide for diabetic macular edema and macular edema secondary to retinal vein occlusion: a meta-analysis.
Mihalache A, Hatamnejad A, Patil SN, et al.
OPHTHALMOLOGICA
2024;247:19–29.