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Vascular endothelial growth factor inhibitors (anti-VEGF) in the management of diabetic macular oedema: a systematic review
  1. Ingrid Zechmeister-Koss1,
  2. Mirjana Huić2
  1. 1Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria
  2. 2Department for Development, Research and Health Technology, Agency for Quality and Accreditation in Health, Zagreb, Croatia
  1. Correspondence to Ingrid Zechmeister-Koss, Ludwig Boltzmann Institute for Health Technology Assessment, Garnisongasse 7/20, 1090 Wien, Austria; ingrid.zechmeister{at}


Background and research question The authors address the question of whether vascular endothelial growth factor inhibitors (anti-VEGF) lead to better clinical outcomes than current treatments in patients with clinically manifest diabetic macular oedema (DMO), which is the leading cause of vision loss in the working age population in developed countries.

Methods The authors performed a systematic literature search in common databases and compiled the evidence according to the GRADE methodology. The authors analysed clinically relevant improvement of visual acuity, vision-related quality of life and local or systemic adverse events.

Results In a proportion of patients (on average 25%), VEGF inhibitors result in better visual acuity (≥15 ETDRS letters or equivalent) than in patients treated with laser photocoagulation or sham injection. The number of injections required for long-term improvement as well as the general long-term efficacy is unknown. The evidence is not sufficient to confirm safety of the products in patients with DMO and does not suggest superiority of a single product.

Conclusion For some patients with DMO, VEGF inhibitors seem to be more effective as a short-term treatment option than alternative therapies. The evidence is not of sufficient quality to confirm safety. Decisions on financing should take into account the high price difference between the products and ongoing research.

  • Vascular endothelial growth factor inhibitors
  • bevacizumab
  • ranibizumab
  • pegaptanib
  • diabetic macular oedema
  • laser photocoagulation
  • intravitreal steroid injection

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  • Funding The research was financially supported by the Austrian Ministry of Health. Collaboration between the Austrian and the Croatian researchers was initiated via the European network on HTA (EUnetHTA)/workpackage 7. EU-grant no. 2009 23 02.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.