OCT-guided Comparative Efficacy of Anti-VEGF Agents for Diabetic Macular Edema: A Systematic Review and Meta-Analysis
Sittikorn Laojaroenwanit*, Napa Suebsaiphrom, Thisarin Takkametha and Nawinda Vanichakulthada
ABSTRACT
Background: Diabetic macular edema (DME) demonstrates variable response to anti-vascular endothelial growth factor (anti-VEGF) therapy. Optical coherence tomography (OCT) biomarkers may predict differential treatment responses.
Methods: We searched MEDLINE, Embase, CENTRAL, PubMed, and Scopus through January 2026. Random-effects meta-analysis was performed with subgroup analyses by OCT features.
Results: Forty-eight studies (18 RCTs, 30 observational) involving 11,342 eyes were included. Anti-VEGF therapy improved BCVA by +9.8 letters (95% CI: 8.9-10.7) and reduced CRT by -148.3 μm (95% CI: -162.1 to -134.5). Aflibercept showed superior BCVA improvement versus bevacizumab (MD: +2.4 letters, p<0.001). Eyes with SRF showed greater visual gains (MD: +2.8 letters, p<0.001). DRIL presence was associated with poorer outcomes (MD: -4.2 letters, p<0.001).
Conclusion: OCT biomarkers significantly influence anti-VEGF treatment outcomes in DME. SRF presence predicts favorable response, while DRIL
indicates poor prognosis.
