Efficacy of topical nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of diabetic macular edema (DME): a systematic review and meta-analysis

OBJECTIVE: To assess the efficacy of topical nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with Diabetic Macular Edema (DME). METHODS: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases, including MEDLINE, EMBASE, PubMED, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL), were comprehensively searched for relevant studies published by December 2023 using key words such as 'diabetic macular edema', 'topical NSAIDS', and 'anti-VEGF'. All studies focusing on the treatment diabetic macular edema using NSAIDS versus anti-VEGF were considered, including interventional, observational, pilot, and randomized controlled trials, and the data from the selected studies were pooled for analysis. The primary outcome measured was best-corrected visual acuity (BCVA), while secondary outcomes included central macular thickness (CMT), macular volume, and complications. RESULTS: Six studies, with a total sample size of 446 patients and 892 eyes, were included. The findings showed a statistically significant improvement in BCVA favoring the NSAIDs group (mean difference: 1.82, 95% CI: 0.12 to 3.53) with moderate heterogeneity (I^2 = 60%, P = 0.08). CMT showed a favorable trend towards the NSAIDs group with a mean difference of 51.84 μm (95% CI: -15.23 to 118.91), although this was not statistically significant, with high heterogeneity (I^2 = 91%, P < 0.0001). Macular volume analysis showed no statistically significant difference in macular volume between the groups (mean difference: 0.29, 95% CI: -0.36 to 0.95), with high heterogeneity observed (I^2 = 77%, P = 0.04). CONCLUSION: This study showed that topical NSAIDs, alone or combined with anti-VEGF therapy significantly improved BCVA; however, the reduction in CMT was not significant. Evidence for macular volume reduction remains insufficient.