Assessing Long-Term Feasibility and Efficacy of Treatments for Retinal Vein Occlusion Macular Edema: A Systematic Review and Network Meta-Analysis of Randomized Clinical Trials.

OBJECTIVE: This network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluates the long-term efficacy and feasibility of treatments for macular edema (ME) secondary to retinal vein occlusion (RVO). Comparisons between different alternatives remain unclear.

METHODS: We used a Bayesian framework to perform an NMA of treatments for ME secondary to RVO. We searched for relevant RCTs with at least 12 months of follow-up in PubMed, Scopus, Web of Science, and Cochrane databases. Efficacy outcomes included changes in best-corrected visual acuity and central macular thickness, while feasibility outcomes focused on the mean number of injections and dropout rates.

RESULTS: We included 3,431 patients from 21 RCTs. We compared 8 treatment modalities: aflibercept, ranibizumab 0.3, ranibizumab 0.5 mg, bevacizumab, dexamethasone, dexamethasone plus anti- Vascular Endothelial Growth Factor (VEGF), laser, and anti-VEGF plus laser. Dexamethasone combined with anti-VEGF treatment was found to be the most effective and feasible. Aflibercept was the top option when used alone, followed by bevacizumab and ranibizumab. Laser alone, dexamethasone alone, and laser combined with anti-VEGF treatment showed the lowest long-term effectiveness and feasibility.

CONCLUSION: Dexamethasone plus anti-VEGF is a potential long-term option for effectiveness. Despite the need for repeated injections, aflibercept stands out as a leading choice.