Effectiveness and Safety of Laser Photocoagulation plus Intravitreal Triamcinolone for Diabetic Macular Edema: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

XU Changqin ,  MA Lingjun

Department of Ophthalmology, China-Japan Union Hospital, Jilin University, Changchun 130033, China;

Corresponding author：

MA Lingjun, Email: ljma@jlu.edu.cn

Keywords：

Laser photocoagulation; Intravitreal triamcinolone; Intravitreous injection; Diabetic macular edema; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20120125

Video：

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Objective 　To evaluate the single-use of laser photocoagulation (LP) and the combined-use of laser photocoagulation plus intravitreal triamcinolone (LP+IVTA) for diabetic macular edema (DME) in terms of clinical therapeutic effect and safety.
Methods 　Such databases as The Cochrane Library, Medline, Embase, CBM, CNKI and Wanfang Data were searched from the date of their establishment to September 2011, and the references of all included studies were also traced, so as to identify the randomized controlled trials (RCTs) on LP vs. LP+IVTA for DME. The quality assessment and data extraction were conducted in accordance with the Cochrane Handbook 5.0 by two reviewers independently, and then Meta-analyses were conducted using RevMan 5.0 software.
Results 　Ten RCTs involving 525 ill eyes were included, and all of them were classified as Grade B in methodological quality. Results of meta-analysis showed that: at the end of follow-up, there were significant differences between the LP+IVTA group and the LP group in the best corrected visual acuity (BCVA) (RR=–0.14, 95%CI –0.20 to –0.08, P lt;0.000 01), and the central macular thickness (CMT) (RR=–56.78, 95%CI –84.03 to –29.54, P lt;0.000 1). In comparison with the LP group, there were more people in the LP+IVTA group who needed to be treated for their elevated intraocular pressure and to have surgery for the progression of cataract. But no significant difference was found between the two groups in vitreous hemorrhage, retinal detachment, retinal vein occlusion and macular epiretinal membrane.
Conclusion 　Current evidence of clinical research shows that the LP+IVTA is superior to LP in reducing macular edema and improving vision in the treatment of diabetic macular edema, but it may also result in a high incidence of elevated intraocular pressure and cataract. Because the methodological quality limitation of included studies may affect the authenticity of outcomes, this conclusion has to be further proved by more high-quality and large-scale clinical trials.

Citation： XU Changqin,MA Lingjun. Effectiveness and Safety of Laser Photocoagulation plus Intravitreal Triamcinolone for Diabetic Macular Edema: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2012, 12(7): 817-821. doi: 10.7507/1672-2531.20120125 Copy

1.	Klein R, Klein BE, Moss SE. Visual impairment in diabetes. Ophthalmology, 1984, 91(1): 1-9.
2.	刘谊, 严密. 曲安奈德玻璃体腔注射的临床应用. 中华眼底病杂志, 2003, 19(4): 263-265.
3.	Gillies MC, McAllister IL, Zhu MD, et al. Intravitreal triamcinolone prior to laser treatment of diabetic macular edema: 24-month results of a randomized controlled trial. Ophthalmology, 2011, 118(5): 866-872.
4.	Maia OO, Takahashi BS, Costa RA, et al. Combined laser and intravitreal triamcinolone for proliferative diabetic retinopathy and macular edema: one-year results of a randomized clinical trial. Am J Ophthalmol, 2009, 147(2): 291-297.
5.	Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol, 1985, 103(12): 1796-1806.
6.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7.	Wong TY, McAllister IL, Zhu M, et al. Intravitreal Triamcinolone and Laser versus Laser Alone for Treatment of Diabetic Macular Edema: 24-Month Results of a Mult-Center, Prospective, Randomized Controlled Trial. ARVO Meeting Abstracts April 11, 2010, 51: 6425.
8.	罗翠平, 田锁成, 李慧俐, 等.曲安奈德玻璃体内注射联合黄斑部格栅样光凝治疗糖尿病性黄斑水肿的临床观察. 眼科新进展, 2010, 30(9): 851-853.
9.	杨奇志. 曲安奈德联合激光治疗糖尿病性黄斑水肿疗效分析. 中国现代药物应用, 2010, 4(5): 126-127.
10.	王永波, 石安娜, 石浔, 等. 糖尿病性黄斑水肿联合治疗的临床观察. 眼科学报, 2010, 25(1): 22-25.
11.	李厚刚, 赵霞, 李冬育, 等. 视网膜光凝联合玻璃体腔注射曲安奈德治疗糖尿病性黄斑水肿.中国实用眼科杂志, 2009, 27(9): 1038-1040.
12.	盛艳娟, 王玉, 舒相汶. 曲安奈德玻璃体腔注射联合激光光凝治疗糖尿病性黄斑水肿24例. 山东大学耳鼻喉眼学报, 2008, 22(6): 541-543.
13.	Mirshahi A, Shenazandi H, Lashay A, et al. Intravitreal triamcinolone as an adjunct to standard laser therapy in coexisting high-risk proliferative diabetic retinopathy and clinically significant macular edema. Retina, 2010, 30(2): 254-259.
14.	Lee HY, Lee SY, Park JS. Comparison of photocoagulation with combined intravitreal triamcinolone for diabetic macular edema. Korean J Ophthalmol, 2009, 23(3): 153-158.
15.	Lam DS, Chan CK, Mohamed S, et al. Intravitreal triamcinolone plus sequential grid laser versus triamcinolone or laser alone for treating diabetic macular edema: six-month outcomes. Ophthalmology, 2007, 114(12): 2162-2167.
16.	Tano Y, Chandler D, Machemer R. Treatment of intraocular proliferation with intravitreal injection of triamcinolone acetonide. Am J Ophthalmol, 1980, 90(6): 810-816.
17.	Martidis A, Duker JS, Greenberg PB, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology, 2002, 109(5): 920-927.

1. Klein R, Klein BE, Moss SE. Visual impairment in diabetes. Ophthalmology, 1984, 91(1): 1-9.
2. 刘谊, 严密. 曲安奈德玻璃体腔注射的临床应用. 中华眼底病杂志, 2003, 19(4): 263-265.
3. Gillies MC, McAllister IL, Zhu MD, et al. Intravitreal triamcinolone prior to laser treatment of diabetic macular edema: 24-month results of a randomized controlled trial. Ophthalmology, 2011, 118(5): 866-872.
4. Maia OO, Takahashi BS, Costa RA, et al. Combined laser and intravitreal triamcinolone for proliferative diabetic retinopathy and macular edema: one-year results of a randomized clinical trial. Am J Ophthalmol, 2009, 147(2): 291-297.
5. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol, 1985, 103(12): 1796-1806.
6. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7. Wong TY, McAllister IL, Zhu M, et al. Intravitreal Triamcinolone and Laser versus Laser Alone for Treatment of Diabetic Macular Edema: 24-Month Results of a Mult-Center, Prospective, Randomized Controlled Trial. ARVO Meeting Abstracts April 11, 2010, 51: 6425.
8. 罗翠平, 田锁成, 李慧俐, 等.曲安奈德玻璃体内注射联合黄斑部格栅样光凝治疗糖尿病性黄斑水肿的临床观察. 眼科新进展, 2010, 30(9): 851-853.
9. 杨奇志. 曲安奈德联合激光治疗糖尿病性黄斑水肿疗效分析. 中国现代药物应用, 2010, 4(5): 126-127.
10. 王永波, 石安娜, 石浔, 等. 糖尿病性黄斑水肿联合治疗的临床观察. 眼科学报, 2010, 25(1): 22-25.
11. 李厚刚, 赵霞, 李冬育, 等. 视网膜光凝联合玻璃体腔注射曲安奈德治疗糖尿病性黄斑水肿.中国实用眼科杂志, 2009, 27(9): 1038-1040.
12. 盛艳娟, 王玉, 舒相汶. 曲安奈德玻璃体腔注射联合激光光凝治疗糖尿病性黄斑水肿24例. 山东大学耳鼻喉眼学报, 2008, 22(6): 541-543.
13. Mirshahi A, Shenazandi H, Lashay A, et al. Intravitreal triamcinolone as an adjunct to standard laser therapy in coexisting high-risk proliferative diabetic retinopathy and clinically significant macular edema. Retina, 2010, 30(2): 254-259.
14. Lee HY, Lee SY, Park JS. Comparison of photocoagulation with combined intravitreal triamcinolone for diabetic macular edema. Korean J Ophthalmol, 2009, 23(3): 153-158.
15. Lam DS, Chan CK, Mohamed S, et al. Intravitreal triamcinolone plus sequential grid laser versus triamcinolone or laser alone for treating diabetic macular edema: six-month outcomes. Ophthalmology, 2007, 114(12): 2162-2167.
16. Tano Y, Chandler D, Machemer R. Treatment of intraocular proliferation with intravitreal injection of triamcinolone acetonide. Am J Ophthalmol, 1980, 90(6): 810-816.
17. Martidis A, Duker JS, Greenberg PB, et al. Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology, 2002, 109(5): 920-927.

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Effectiveness and Safety of Laser Photocoagulation plus Intravitreal Triamcinolone for Diabetic Macular Edema: A Meta-Analysis

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