Intravitreal Bevacizumab Alone Vs Combined With Topical Timolol-Dorzolamide or Dorzolamide for Diabetic Macular Edema: A Systematic Review and Meta-Analysis

Rahaf A Hubayni,1,2 Jumanah Qedair,1,2 Ziad M Bukhari,3 Ali S Alsudais,1,2 Orjwan Salah Badghaish,1,2 Razan Osama Bawazir,1,2 Abdullah S AlQahtani,1– 3 Hashem Almarzouki1– 3 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 2King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; 3Ophthalmology Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi ArabiaCorrespondence: Rahaf A Hubayni, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia, Email [email protected]: Diabetic macular edema (DME) is a major cause of vision loss in diabetes. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of intravitreal bevacizumab (IVB) combined with topical timolol-dorzolamide versus dorzolamide alone in DME patients.Patients and Methods: A literature search was conducted across multiple databases until March 2024. Randomized controlled trials (RCTs) comparing IVB (1.25 mg, monthly) with topical dorzolamide-timolol (twice daily) or dorzolamide alone (twice daily) were included. Primary outcomes assessed were best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) at various intervals.Results: Four RCTs involving 98 patients (150 eyes) were analyzed, with a mean age of 57.9 years and a female predominance (55.1%). The subgroup meta-analysis indicated a weighted mean difference (WMD) in BCVA of − 0.125 [95% CI: − 0.21 to − 0.041]. The IVB+D group showed no significant difference in WMD compared to the IVB and IVB+TD groups. IOP measurements revealed a WMD of − 1.244 mmHg [95% CI: − 2.548 mmHg to 0.06 mmHg], with a significant increase in the IVB group compared to the IVB+D and IVB+TD groups. CMT analysis showed a WMD of − 78.875 μm [95% CI: − 118.606 μm to − 39.145 μm], with no significant differences among groups.Conclusion: Concurrent IVB with topical timolol-dorzolamide or dorzolamide alone demonstrated similar efficacy in improving BCVA and CMT in DME patients. However, the IVB+TD combination resulted in a more significant reduction in IOP compared to IVB alone.Keywords: diabetic macular edema, intravitreal bevacizumab, anti-vascular endothelial growth factor, retinal disorders, timolol-dorzolamide