Objective:
To assess the efficacy of topical NSAIDs as adjunctive therapy for diabetic macular edema (DME).
Approach:
- Study Design: Systematic review and meta-analysis of six studies involving 446 patients and 892 eyes.
- Interventions: Topical NSAIDs (bromfenac, ketorolac, nepafenac) administered alone or with intravitreal anti-VEGF therapy.
- Endpoints: Primary endpoint was best-corrected visual acuity (BCVA); secondary endpoints included central macular thickness (CMT) and macular volume.
Key Findings:
- Pooled analysis showed a statistically significant improvement in BCVA with topical NSAIDs, with a mean difference of 1.82 ETDRS letters, although the clinical relevance of this improvement is uncertain as it is below the standard change deemed clinically meaningful.
- Meta-analysis indicated a trend toward greater CMT reduction in NSAID-treated eyes, but it did not reach statistical significance.
- No meaningful benefit was observed for macular volume reduction between treatment groups.
Interpretation:
The evidence does not support a clear anatomical advantage of topical NSAIDs in DME management.
Limitations:
- High heterogeneity across studies in anatomical outcomes.
- Insufficient evidence to define the long-term role of NSAIDs in treatment algorithms.
Conclusion:
The current evidence does not support a clear anatomical advantage or define the long-term role of topical NSAIDs in treatment algorithms.
Sources:
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