Anti-VEGF Therapies for Diabetic Retinopathy: A Meta-Analysis

Abstract

Diabetic retinopathy (DR) is a leading cause of vision impairment and blindness globally, necessitating effective therapeutic strategies. This meta-analysis evaluated the efficacy and safety of anti-vascular endothelial growth factor (anti-VEGF) therapies in the treatment of DR, synthesizing data from randomized controlled trials involving agents such as bevacizumab, ranibizumab, and aflibercept. A comprehensive literature search across PubMed, Embase, and the Cochrane Library identified eligible studies comparing anti-VEGF interventions with sham, laser photocoagulation, or other pharmacologic treatments. The analysis revealed that anti-VEGF therapy significantly improved best-corrected visual acuity (BCVA), with mean improvements ranging from 0.18 to 0.2 logMAR across studies. Central retinal thickness (CRT) reductions averaged over 100 µm, underscoring the anatomical efficacy of treatment. A substantial proportion of patients achieved meaningful vision gains, with ≥15 letters improvement in up to 50% of cases. Moreover, the safety profile of anti-VEGF agents was favorable, with low incidences of ocular (4–6%) and systemic (2–3%) adverse events. Subgroup analyses indicated that the type of anti-VEGF agent, dosing protocol, and baseline disease characteristics significantly influenced treatment outcomes. While the clinical benefits of anti-VEGF therapy are evident, challenges such as patient non-responsiveness and frequent injection requirements persist. Future directions include the development of nanoparticle-based delivery systems, combination therapies with corticosteroids or laser, and exploration of novel agents including plant-derived compounds. These findings affirm that anti-VEGF therapy constitutes a central component of evidence-based DR management and highlight the ongoing need for innovations that enhance efficacy, safety, and accessibility. This study provides critical insights to inform clinical decision-making and guide future research on optimizing DR treatment paradigms.