Cochrane · systematic review · CD005656
Intravitreal steroids for macular edema in diabetes
Rittiphairoj, T, Mir, TA, Li, T, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Eyes and VisionAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
36
current version
GRADE rated
32
No studies
4
Included studies
NR
No studies 4 · 11.1%Ungraded 0 · 0%Very low 6 · 16.7%Low 11 · 30.6%Moderate 15 · 41.7%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Intravitreal dexamethasone implant 0.7 mg compared to sham for macular edema in diabetes
Population: macular edema in diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in visual acuity (logMAR) ‐ 12 months (negative is better) Intravitreal dexamethasone implant 0.7 mg vs sham | no estimate extracted | 1 study · 701 participants | Moderate Downgraded: imprecision |
Gain of three or more lines visual acuity ‐ 12 months Intravitreal dexamethasone implant 0.7 mg vs sham | RR 1.39 [0.91, 2.12] | 1 study · 701 participants | Moderate Downgraded: imprecision |
Change of retinal thickness ‐ 36 months (negative is better) Intravitreal dexamethasone implant 0.7 mg vs sham | no estimate extracted | 1 study · 701 participants | Moderate Downgraded: risk of bias |
Cataract progression ‐ 36 months Intravitreal dexamethasone implant 0.7 mg vs sham | RR 3.89 [2.75, 5.5] | 1 study · 697 participants | Moderate Downgraded: risk of bias |
Use of IOP‐lowering medications ‐ 36 months Intravitreal dexamethasone implant 0.7 mg vs sham | RR 4.54 [3.19, 6.46] | 1 study · 697 participants | Moderate Downgraded: risk of bias |
Surgery for glaucoma ‐ 36 months Intravitreal dexamethasone implant 0.7 mg vs sham | RR 5.04 [0.59, 42.95] | 1 study · 697 participants | Low Downgraded: risk of bias, imprecision |
Intravitreal dexamethasone implant 0.7 mg compared to intravitreal antiVEGF for macular edema in diabetes
Population: macular edema in diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in visual acuity (logMAR) ‐ 12 months (negative is better) Intravitreal dexamethasone implant 0.7 mg vs intravitreal antiVEGF | no estimate extracted | NR | Moderate Downgraded: risk of bias |
Gain of three or more lines visual acuity ‐ 12 months Intravitreal dexamethasone implant 0.7 mg vs intravitreal antiVEGF | RR 0.99 | NR | Low Downgraded: risk of bias, inconsistency |
Change in retinal thickness (micron) ‐ 12 months (negative is better) Intravitreal dexamethasone implant 0.7 mg vs intravitreal antiVEGF | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision |
Cataract progression ‐ 12 to 24 months Intravitreal dexamethasone implant 0.7 mg vs intravitreal antiVEGF | RR 4.23 [2.36, 7.59] | NR | Moderate Downgraded: risk of bias |
Use of IOP‐lowering medications ‐ 24 months Intravitreal dexamethasone implant 0.7 mg vs intravitreal antiVEGF | RR 4.76 [2.84, 7.99] | NR | Moderate Downgraded: risk of bias |
Surgery for glaucoma ‐ 24 months Intravitreal dexamethasone implant 0.7 mg vs intravitreal antiVEGF | RR 3.02 [0.12, 73.56] | NR | Very low Downgraded: risk of bias, imprecision |
Intravitreal fluocinolone acetonide implant 0.19 mg compared to sham for macular edema in diabetes
Population: macular edema in diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in visual acuity (logMAR) ‐ 12 months (negative is better) Intravitreal fluocinolone acetonide implant 0.19 mg vs sham | no estimate extracted | 1 study · 560 participants | Moderate Downgraded: risk of bias |
Gain of three or more lines visual acuity ‐ 12 months Intravitreal fluocinolone acetonide implant 0.19 mg vs sham | RR 1.79 [1.16, 2.78] | 1 study · 560 participants | Moderate Downgraded: risk of bias |
Change in retinal thickness (micron) ‐ 12 months (negative is better) Intravitreal fluocinolone acetonide implant 0.19 mg vs sham | no estimate extracted | 1 study · 560 participants | Moderate Downgraded: risk of bias |
Cataract progression ‐ 24 months Intravitreal fluocinolone acetonide implant 0.19 mg vs sham | RR 1.63 [1.35, 1.97] | 1 study · 355 participants | Moderate Downgraded: risk of bias |
Use of IOP‐lowering medications ‐ 24 months Intravitreal fluocinolone acetonide implant 0.19 mg vs sham | RR 2.72 [1.87, 3.98] | 1 study · 558 participants | Moderate Downgraded: risk of bias |
Surgery for glaucoma ‐ 24 months Intravitreal fluocinolone acetonide implant 0.19 mg vs sham | RR 9.54 [1.28, 70.93] | 1 study · 558 participants | Low Downgraded: risk of bias, imprecision |
Intravitreal triamcinolone acetonide injection 4 mg compared to sham for macular edema in diabetes
Population: macular edema in diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in visual acuity (logMAR) ‐ 24 months** (negative is better) Intravitreal triamcinolone acetonide injection 4 mg vs sham | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision |
Gain of three or more lines visual acuity ‐ 24 months** Intravitreal triamcinolone acetonide injection 4 mg vs sham | RR 4.12 [0.48, 34.99] | NR | Very low Downgraded: risk of bias, imprecision |
Change in retinal thickness (micron) ‐ 24 months** (negative is better) Intravitreal triamcinolone acetonide injection 4 mg vs sham | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision |
Cataract progression ‐ 24 months Intravitreal triamcinolone acetonide injection 4 mg vs sham | RR 3 [0.97, 9.3] | NR | Low Downgraded: risk of bias, imprecision |
Use of IOP‐lowering medications ‐ 24 months Intravitreal triamcinolone acetonide injection 4 mg vs sham | RR 21.6 [1.32, 354.7] | NR | Very low Downgraded: risk of bias, imprecision |
Surgery for glaucoma ‐ 24 months Intravitreal triamcinolone acetonide injection 4 mg vs sham | no estimate extracted | NR | No studies |
Intravitreal triamcinolone acetonide injection 4 mg compared to macular laser for macular edema in diabetes
Population: macular edema in diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in visual acuity (logMAR) ‐ 12 months (negative is better) Intravitreal triamcinolone acetonide injection 4 mg vs macular laser | MD 0.02 | NR | Very low Downgraded: risk of bias, inconsistency |
Gain of three or more lines visual acuity ‐ 12 months Intravitreal triamcinolone acetonide injection 4 mg vs macular laser | RR 0.85 [0.55, 1.3] | NR | Low Downgraded: risk of bias, imprecision |
Change in retinal thickness (micron) (negative is better) Intravitreal triamcinolone acetonide injection 4 mg vs macular laser | MD 5 | NR | Very low Downgraded: risk of bias, inconsistency |
Cataract progression ‐ 9 to 24 months Intravitreal triamcinolone acetonide injection 4 mg vs macular laser | RR 2.68 [2.21, 3.24] | NR | Moderate Downgraded: risk of bias |
Use of IOP‐lowering medications ‐ 9 to 24 months Intravitreal triamcinolone acetonide injection 4 mg vs macular laser | RR 3.92 [2.59, 5.96] | NR | Moderate Downgraded: risk of bias |
Surgery for glaucoma ‐ 9 to 24 months Intravitreal triamcinolone acetonide injection 4 mg vs macular laser | RR 11.68 [0.63, 216] | NR | Low Downgraded: risk of bias, imprecision |
Intravitreal triamcinolone acetonide injection 4 mg compared to antiVEGF for macular edema in diabetes
Population: macular edema in diabetes
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in visual acuity (logMAR) ‐ 12 months (negative is better) Intravitreal triamcinolone acetonide injection 4 mg vs antiVEGF | no estimate extracted | 1 study · 30 participants | Low Downgraded: risk of bias, imprecision |
Gain of three or more lines visual acuity Intravitreal triamcinolone acetonide injection 4 mg vs antiVEGF | no estimate extracted | NR | No studies |
Change in central retinal thickness (micron) ‐ 12 months (negative is better) Intravitreal triamcinolone acetonide injection 4 mg vs antiVEGF | no estimate extracted | 1 study · 30 participants | Very low Downgraded: risk of bias, inconsistency |
Cataract progression Intravitreal triamcinolone acetonide injection 4 mg vs antiVEGF | no estimate extracted | NR | No studies |
Use of IOP‐lowering medications Intravitreal triamcinolone acetonide injection 4 mg vs antiVEGF | no estimate extracted | NR | Low Downgraded: risk of bias, imprecision, inconsistency |
Surgery for glaucoma Intravitreal triamcinolone acetonide injection 4 mg vs antiVEGF | no estimate extracted | NR | No studies |