Subthreshold diode micropulse laser versus conventional laser photocoagulation monotherapy or combined with anti-VEGF therapy for diabetic macular edema: A Bayesian network meta-analysis

Aims: To assess the effects of laser photocoagulation as monotherapy or adjuvant therapy for the treatment of DME. Methods: A search of the Cochrane Library, Pubmed, Embase, and the clinicaltrial.gov registry for randomized clinical trials comparing any two treatments of interest (SDMLP monotherapy, CLP monotherapy, CLP plus anti-VEGF therapy) was performed. Data were collected and pooled by Bayesian network meta-analyses which accounts for both direct and indirect comparisons. The primary outcome was the mean change in best-corrected visual acuity measured by the logarithm of the minimal angle of resolution units. The secondary outcome was the mean change in central macular thickness from baseline to month 12. Results: Ranibizumab therapy combined with CLP was more effective than SDMLP alone (MD, -0.396; 95% CrI, -0.746 to -0.062) and CLP alone (MD, -0.621; 95% CrI, -0.823 to -0.431). There was no apparent difference of efficacy between SDMLP alone and CLP alone (MD,-0.225; 95% CrI,-0.501 to 0.058). There was no apparent difference of efficacy between SDMLP alone and Bevacizumab therapy combined with CLP (MD, -0.003, 95% CrI, -0.815 to 0.805). Conclusion: There was no apparent difference on improving vision between SDMLP monotherapy and CLP monotherapy. The most effective treatment in the network was ranibizumab therapy combined with CLP followed by SDMLP monotherapy, Bevacizumab therapy combined with CLP, and CLP monotherapy in rank order.