Aflibercept with and without laser therapy in diabetic macular edema: a systematic review and meta-analysis

Background Diabetic macular edema (DME) causes visual impairment in diabetic patients. Aflibercept is a standard treatment of DME; however, the benefit of combining it with laser therapy remains uncertain.Methods A systematic review of randomized controlled trials (RCTs) comparing aflibercept alone with a combination of aflibercept plus laser therapy for management of DME was conducted. PubMed, Cochrane Library, and Embase were searched according to PRISMA guidelines. Primary outcomes were best corrected visual acuity (BCVA) and central macular thickness (CMT), while secondary outcome was treatment burden.Results Six RCTs involving 275 patients were included. At 12 months, combination therapy yielded a modest improvement in BCVA (mean difference [MD] = 0.18; 95% CI: −0.17 to 0.52; p = 0.32) and a minor reduction in CMT (MD = 0.13 μm; 95% CI: −0.13 to 0.39; p = 0.32). The number of aflibercept injections was slightly lower in the combination group (MD = -0.53 injections; 95% CI: −1.23 to 0.17; p = 0.14).Conclusions The adjunctive use of laser therapy with aflibercept in DME does not provide statistically significant improvement in visual or anatomical outcomes over aflibercept alone.