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2016 ; 2016
(ä): ä Nephropedia Template TP
BMJ Clin Evid
2016[Mar]; 2016
(ä): ä PMID27031563
show ga
INTRODUCTION: Diabetic retinopathy is the most common microvascular complication
of diabetes. It is also the most common cause of blindness in working-age adults
in industrialised nations. Older people and those with worse diabetes control,
hypertension, and hyperlipidaemia are most at risk. Diabetic macular oedema,
which can occur at any stage of diabetic retinopathy, is related to increased
vascular permeability and breakdown of the blood retinal barrier, in part related
to increased vascular endothelial growth factor (VEGF) levels. About 1% to 3% of
people with diabetes suffer vision loss because of diabetic macular oedema.
METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the
following clinical questions: What are the effects of intravitreal VEGF
inhibitors versus each other for diabetic macular oedema? What are the effects of
intravitreal VEGF inhibitors plus laser therapy versus intravitreal VEGF
inhibitors alone for diabetic macular oedema? We searched: Medline, Embase, The
Cochrane Library, and other important databases up to September 2014 (Clinical
Evidence overviews are updated periodically; please check our website for the
most up-to-date version of this overview). RESULTS: At this update, searching of
electronic databases retrieved 240 studies. After deduplication and removal of
conference abstracts, 149 records were screened for inclusion in the overview.
Appraisal of titles and abstracts led to the exclusion of 90 studies and the
further review of 59 full publications. Of the 59 full articles evaluated, eight
systematic reviews and four RCTs were added at this update. We performed a GRADE
evaluation for four PICO combinations. CONCLUSIONS: In this systematic overview,
we categorised the efficacy for six comparisons based on information about the
effectiveness and safety of intravitreal VEGF inhibitors aflibercept,
bevacizumab, and ranibizumab, and each of these intravitreal VEGF inhibitors plus
laser therapy.