2025/05/30 by Chanyuan Cao, Guoxiao Yu, Zhen Deng +1
Medicine · #Ocular Diseases and Behçet’s Syndrome #Retinal Diseases and Treatments #Retinal Imaging and Analysis
paper · pdf · doi:10.1159/000546682
crossref issued 2025/05/30 · crossref published 2025/05/30 · crossref published-online 2025/05/30 · openalex publication_date 2025/05/30 · crossref created 2025/05/30 · openalex created_date 2025/05/31 · crossref deposited 2025/07/11 · crossref indexed 2026/07/24 · openalex updated_date 2026/07/25
INTRODUCTION: Monthly anti-vascular endothelial growth factors (VEGFs) are the primary line of management of diabetic macular edema (DME). However, a large number of patients do not respond to anti-VEGF and require dexamethasone implants (DEXIs) as a second line of therapy. There remains a clinical conundrum on the optimal timing of the switch to DEXI. We systematically reviewed the literature to assess outcomes after an early versus late switch to DEXI after failed anti-VEGF therapy in DME. METHODS: Relevant studies were identified by searching PubMed, CENTRAL, Scopus, Web of Science, and Embase till 25th December 2024. We assessed changes in central retinal thickness (CRT), best-corrected visual acuity (BCVA), and risk of ocular hypertension between early versus late switch groups. RESULTS: Six studies were included. Pooled analysis of all six studies showed that there was a tendency of improved CRT (MD: 19.01; 95% CI: -27.29, 65.31; I2 = 85%) and BCVA (MD: 0.05; 95% CI: -0.04, 0.14; I2 = 72%) with early switch as compared to late switch group but without statistical significance. Removing one outlier study showed statistically significant improvement in CRT (MD: 36.84; 95% CI: 7.54, 66.14; I2 = 48%) and BCVA with early switch (MD: 0.09; 95% CI: 0.08, 0.11; I2 = 0%). Subgroup analysis based on the definition of late switch indicated better outcomes with an early switch when the late switch was defined as after >6 anti-VEGF injections. No difference was noted in the risk of ocular hypertension between the two groups (OR: 0.81; 95% CI: 0.38, 1.73; I2 = 30%). CONCLUSIONS: An early switch to DEXI may tend toward better outcomes as compared to a late switch in treatment-resistant DME patients. High heterogeneity of the meta-analysis and outlier studies are important limitations of present evidence, which can only be resolved with high-quality randomized controlled trials.