A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Retina/Vitreous Panel: Allen C. Ho, MD; Ingrid U. Scott, MD, MPH; Stephen J. Kim, MD; Gary C. Brown, MD, MBA; Melissa M. Brown, MD, MBA; Michael S. Ip, MD; Franco M. Recchia, MD
Ophthalmology, October 2012, Vol 119, 2179-2188 © 2012 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Objective: To review the evidence regarding the safety and efficacy of current anti-vascular endothelial growth factor (VEGF) pharmacotherapies for the treatment of diabetic macular edema (DME).
Methods: Literature searches last were conducted in September 2011, in PubMed with no date restrictions, limited to articles published in English, and in the Cochrane Library without a language limitation. The combined searches yielded 532 citations, of which 45 were deemed clinically relevant for the authors to review in full text and assign ratings of level of evidence to each of the selected studies with the guidance of the panel methodologists.
Results: At this time, there are 5 studies that provide level I evidence for intravitreal ranibizumab, alone or in combination with other treatments for DME. There is also 1 study that provides level I evidence for intravitreal pegaptanib sodium for DME. Nine studies reviewed were rated as level II, and 2 additional studies reviewed were graded as level III. Most studies do not provide information about long-term results (i.e., greater than 2 years of follow-up) or the comparative efficacy of anti-VEGF pharmacotherapies.
Conclusions: Review of the available literature indicates that anti-VEGF pharmacotherapy, delivered by intravitreal injection, is a safe and efficacious treatment over 2 years for DME. Further evidence is required to support long-term safety of these pharmacotherapies and their comparative efficacy.