Prophylactic interventions for preventing macular edema after cataract surgery in patients with diabetes: A Bayesian network meta-analysis of randomized controlled trials

Background Diabetes significantly increases the risk of postoperative macular edema (PME) after cataract surgery, leading to potential worst post-operative outcomes. This study aims to compare the effect of different prophylactic interventions in improving postoperative anatomic and visual acuity outcomes of diabetes patients who underwent cataract surgery. Methods We searched MEDLINE, Embase, Web of Science databases from inception until February 2nd, 2022, for studies including studies reporting PME events and/or best-corrected visual acuity (BCVA) outcomes. Random-effects Bayesian network meta-analysis was performed to compare the efficiency of intravitreal anti-vascular endothelial growth factor injections (anti-VEGF), nonsteroidal anti-inflammatory drugs (NSAIDs) and topical steroids eye drop at 1 week, 1 month, 3 months, 6 months after cataract surgery. Findings The total of 2566 participants from 17 randomized controlled trials were included in the network meta-analysis, with moderate risk of bias and no evidence of publication of bias. Compared to placebo/steroid eye drop alone, patients received additional topical NSAIDs or intravitreal anti-VEGF injections had lower risk of PME at 1 month (NSAIDs: OR=0.221, 95% Confidence interval [CI], 0.044-0.755, I-2=0.0%, 5 studies; anti-VEGF: OR=0.151, 95%CI, 0.037-0.413, I-2=0.0%, 5 studies) and 3 month (NSAIDs: OR=0.370, 95%CI, 0.140-0.875, I-2=0.0%, 8 studies; anti-VEGF: OR=0.203, 95%CI, 0.101-0.353, I-2 =0.0%, 4 studies) after cataract surgery. Further, additional antiVEGF exhibited better BCVA outcome at 1 month (mean difference of LogMAR: -0.083, 95%CI, -0.17 to -0.014, I-2=62.0%, 5 studies), and 3 months (mean difference of LogMAR: -0.061, 95%CI, -0.11 to -0.011, I-2=0.0%, 5 studies) after cataract surgery. Such additional benefits did not reach statistic significant at 6 months after surgery. Interpretation Our data suggests that compared to placebo/steroid eye drop alone, additional prophylactic anti-VEGF intervention could be considered for preventing the occurrence of PME after cataract surgery in patients with diabetes.