Steroid Implant May Have Potential as a First-line Treatment for DME, Study Suggests

A meta-analysis of 20 studies involving 4,314 eyes with diabetic macular edema found anti-VEGF therapy produced significantly greater improvements in best-corrected visual acuity and central retinal thickness than laser photocoagulation. Steroid treatment with dexamethasone implants achieved larger reductions in retinal thickness and required substantially fewer treatments per year than bevacizumab, supporting a potential expanded role for steroids in selected patients with DME. Photo: Jay Haynie, OD. Click image to enlarge. For patients with diabetes and diabetic retinopathy, diabetic macular edema (DME) is one of the leading causes of vision loss; if left untreated, it can cause a loss of two or more lines of visual acuity (VA) in half of patients with the disease. Currently, the three main therapies used to treat DME include anti-VEGF, steroid treatment and focal laser photocoagulation. Although anti-VEGF is viewed as the gold standard by some, it requires considerable patient time for repeat injections, and not all patients achieve desirable clinical outcomes. A new study published in Advances in Ophthalmology Practice and Research compared all three therapies head to head to determine how each impacted best-corrected visual acuity (BCVA), central retinal thickness (CRT) and treatment burden.  The meta-analysis included 20 studies published between 2007 and 2022 matching the inclusion criteria, representing 4,314 eyes. Follow-up duration averaged 14 months. The topline results reported were:Both mean difference in BCVA and CRT were significantly improved in the anti-VEGF group compared to laser, at 0.14 logMAR and 38.73µm, respectively.The mean number of treatments per year was significantly lower in the laser group compared to anti-VEGF (mean difference: 0.59).The change in CRT (mean difference: -61.17µm) was significantly greater in the steroid (dexamethasone implant only) group compared to anti-VEGF (bevacizumab only).The mean number of treatments per year was significantly lower in the steroid treatment group compared to anti-VEGF (mean difference: -4.29). There was no significant difference in BCVA in the steroid group when compared to laser or anti-VEGF.  Researchers also conducted a subgroup analysis comparing individual anti-VEGF treatments to each other. They reported the change in central retinal thickness was significantly greater in the aflibercept group (mean difference: -37.52µm) when compared to bevacizumab, and no significant difference between aflibercept and bevacizumab for BCVA and injection frequency outcomes. The mean change in CRT was significantly greater in the ranibizumab group (45.02µm) when compared to bevacizumab. There was no significant difference between ranibizumab and bevacizumab for BCVA outcomes. The authors argue that this meta-analysis suggests anti-VEGF treatment is more effective than laser at improving BCVA and CRT, whereas steroid treatment is more effective than anti-VEGF at improving CRT outcomes and requires fewer yearly treatments. “Steroid treatment resulting in better CRT outcomes compared to anti-VEGF confirms the well-known significance of the inflammatory component associated with DME, and steroids’ role in effectively blocking multiple inflammatory pathways,” they wrote. “Another potential benefit of steroids is the reduced frequency of injections (on average, every three to six months, in some instances even longer, depending on the compound).” They also noted that BCVA outcomes were likely inhibited by cataract development. Limitations of this meta-analysis include an inability to assess the change in BCVA between each individual anti-VEGF and each individual steroid. Researchers were also unable to analyze studies that included combination treatment groups and switch protocols. Several potential contributors to heterogeneity were considered, including baseline BCVA. “Formal comparison of baseline BCVA differences was limited because these data were inconsistently reported. Specifically, baseline BCVA was not reported in all studies, and some studies provided only pooled baseline values rather than values stratified by comparison group,” wrote the authors. In conclusion, this study is unique in its comprehensive and comparative approach, according to the researchers. “By integrating data from both randomized clinical trials and real-world evidence, we bridge the gap between controlled environments and everyday clinical practice, offering insights that are more broadly applicable and reflective of patient diversity,” they wrote, calling for further studies to assess the use of steroids as first-line treatment given their improvements in CRT outcomes with fewer injections compared to anti-VEGF.Click here for the journal source. Bobrek CN, et al. A meta-analysis of clinical outcomes in diabetic macular edema in 2025. Advances in Ophthalmology Practice and Research. June 10, 2026. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.