Comparative efficacy and safety of anti-VEGF agents with and without Laser therapy for diabetic macular edema: A network meta-analysis

Objective To compare the efficacy and safety of Conbercept, Ranibizumab, and Aflibercept, alone or combined with laser, for the treatment of diabetic macular edema (DME).Methods We searched PubMed, Cochrane Library, Embase, Web of Science, CNKI, WanFang, and SinoMed until October 2024 for studies on Conbercept, Ranibizumab, and Aflibercept in DME treatment. Bayesian network meta-analysis was conducted in RStudio. Study quality was assessed with the Cochrane ROB.2 and the Confidence in Network Meta-Analysis framework. This study was registered with PROSPERO (CRD42024608409).Results A total of 64 randomized controlled trials, including 7,185 patients, were analyzed in this study. Results indicated that Ranibizumab + laser yielded the most significant improvement in central retinal thickness (CRT) at 3 months (MD -80.98, 95% CI -106.53, -55.64; SUCRA 81.92%), 6 months (-90.19, [-126.05, -54.77]; 81.62%), and 12 months (-134.99, [-194.2, -75.98; 87.56%). Conbercept + laser (3 months: -52.47, [-80.7, -24.14]; 6 months: -52.98, [-94.72, -11.02]) and Ranibizumab monotherapy (3 months: -64.45,[-101.28, -26.77]) also showed statistically significant CRT reductions compared to laser alone, though to a lesser degree than Ranibizumab + laser. For Best-Corrected Visual Acuity (BCVA), both Ranibizumab and Ranibizumab + laser achieved statistically significant gains at 6 and 12 months compared to laser alone, with Ranibizumab + laser consistently ranking highest in efficacy. Safety analysis revealed no significant differences in total adverse event rates across treatments.Conclusion Ranibizumab + laser therapy demonstrated the greatest improvement in CRT and BCVA at 3, 6, and 12 months, with no significant differences in adverse events compared to other anti-VEGF options.