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<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Evidence review for effectiveness of treatments before, during or after cataract surgery for managing non-proliferative diabetic retinopathy, proliferative diabetic retinopathy or diabetic macular oedema - NCBI Bookshelf</title>
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<meta name="citation_keywords" content="Macular Edema">
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<meta name="citation_keywords" content="Cataract Extraction">
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preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng242er9-lrg.png" alt="Cover of Evidence review for effectiveness of treatments before, during or after cataract surgery for managing non-proliferative diabetic retinopathy, proliferative diabetic retinopathy or diabetic macular oedema" /></a></div><div class="bkr_bib"><h1 id="_NBK607258_"><span itemprop="name">Evidence review for effectiveness of treatments before, during or after cataract surgery for managing non-proliferative diabetic retinopathy, proliferative diabetic retinopathy or diabetic macular oedema</span></h1><div class="subtitle">Diabetic retinopathy</div><p><b>Evidence review I</b></p><p><i>NICE Guideline, No. 242</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2024 Aug</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-6437-6</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2024.</div></div><div class="bkr_clear"></div></div><div id="niceng242er9.s1"><h2 id="_niceng242er9_s1_">1. Evidence review for treatments before, during or after cataract surgery</h2><div id="niceng242er9.s1.1"><h3>1.1. Review question</h3><p>In people who are about to undergo or who have undergone cataract surgery, what is the effectiveness of treatments (before, during or after surgery) for managing:
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<ul><li class="half_rhythm"><div>non-proliferative diabetic retinopathy</div></li><li class="half_rhythm"><div>proliferative diabetic retinopathy</div></li><li class="half_rhythm"><div>diabetic macular oedema?</div></li></ul></p><div id="niceng242er9.s1.1.1"><h4>1.1.1. Introduction</h4><p>It is currently unclear which treatments are most effective at managing non-proliferative diabetic retinopathy, proliferative diabetic retinopathy, or diabetic macular oedema when people have cataract surgery. The aim of this review is to assess evidence in this area to determine which is the most effective treatment and whether the effectiveness of treatment differs depending on whether it is given before, during or after cataract surgery.</p><p>This evidence review informs recommendations in the NICE guideline on the management and treatment of diabetic retinopathy, which is a new NICE guideline in this area.</p></div><div id="niceng242er9.s1.1.2"><h4>1.1.2. Summary of the protocol</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng242er9tab1"><a href="/books/NBK607258/table/niceng242er9.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img" rid-ob="figobniceng242er9tab1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng242er9.tab1"><a href="/books/NBK607258/table/niceng242er9.tab1/?report=objectonly" target="object" rid-ob="figobniceng242er9tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Effectiveness of treatments before, during or after cataract surgery for managing non-proliferative diabetic retinopathy, proliferative diabetic retinopathy or diabetic macular oedema. </p></div></div></div><div id="niceng242er9.s1.1.3"><h4>1.1.3. Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng242er9.appa">appendix A</a> and the <a href="/books/NBK607258/bin/NG242-Methods.pdf">methods</a> document.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng242er9.s1.1.4"><h4>1.1.4. Effectiveness evidence</h4><div id="niceng242er9.s1.1.4.1"><h5>1.1.4.1. Included studies</h5><p>An initial database search found 2787 references, all of which were screened at title and abstract. 62 records were ordered for full text screening, of which 52 were excluded and 10 papers (from 9 RCTs) were included in the review. One of the RCTs reported results for 2 of the population groups as part of a subgroup analysis (people with non-proliferative diabetic retinopathy and people with non-proliferative diabetic retinopathy with diabetic macular oedema). The protocol specified that observational studies would be included for comparisons where RCT evidence was not available. However, for the comparisons where there was no RCT evidence, no observational studies met the inclusion criteria. Therefore, only RCT evidence was included in the review. 70 additional studies were identified in the re-run searches, but none met the inclusion criteria for this review.</p><p>Of the 3 populations identified in the protocol, evidence was available for people with non-proliferative diabetic retinopathy, and people with non-proliferative diabetic retinopathy with diabetic macula oedema. None of the evidence for people with proliferative diabetic retinopathy met the inclusion criteria for this review. Evidence was available for the following comparisons:</p><p>People with non-proliferative diabetic retinopathy
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<ul><li class="half_rhythm"><div>Anti-VEGFs vs control (During surgery – 3 RCTs)</div></li><li class="half_rhythm"><div>Steroids vs control (During surgery – 2 RCTs)</div></li></ul></p><p>People with non-proliferative diabetic retinopathy with diabetic macula oedema
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<ul><li class="half_rhythm"><div>Anti-VEGFs vs control (During surgery – 1 RCT, After surgery – 1 RCT)</div></li><li class="half_rhythm"><div>Steroids vs control (During surgery – 1 RCT)</div></li><li class="half_rhythm"><div>Anti-VEGFs vs steroids (During surgery – 2 papers from 1 RCT)</div></li><li class="half_rhythm"><div>Steroids before vs after surgery (1 RCT)</div></li></ul></p></div><div id="niceng242er9.s1.1.4.2"><h5>1.1.4.2. Excluded studies</h5><p>See <a href="#niceng242er9.appj">Appendix J</a> for excluded studies and reasons for exclusion.</p></div></div><div id="niceng242er9.s1.1.5"><h4>1.1.5. Summary of studies included in the effectiveness evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng242er9tab2"><a href="/books/NBK607258/table/niceng242er9.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img" rid-ob="figobniceng242er9tab2"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng242er9.tab2"><a href="/books/NBK607258/table/niceng242er9.tab2/?report=objectonly" target="object" rid-ob="figobniceng242er9tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Table of included studies: People with non-proliferative diabetic retinopathy. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng242er9tab3"><a href="/books/NBK607258/table/niceng242er9.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img" rid-ob="figobniceng242er9tab3"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng242er9.tab3"><a href="/books/NBK607258/table/niceng242er9.tab3/?report=objectonly" target="object" rid-ob="figobniceng242er9tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Table of included studies: People with non-proliferative diabetic retinopathy with diabetic macular oedema. </p></div></div><p>See <a href="#niceng242er9.appd">Appendix D</a> for full evidence tables</p></div><div id="niceng242er9.s1.1.6"><h4>1.1.6. Summary of the effectiveness evidence</h4><p>Effectiveness evidence was interpreted as, a mean difference less than 0 favours the intervention (anti-VEGF treatment) and a mean difference greater than 0 favours the control arm (placebo). If the confidence interval crosses the line of no effect (0) this would be interpreted as could not distinguish an effect between both treatments.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng242er9tab4"><a href="/books/NBK607258/table/niceng242er9.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img" rid-ob="figobniceng242er9tab4"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng242er9.tab4"><a href="/books/NBK607258/table/niceng242er9.tab4/?report=objectonly" target="object" rid-ob="figobniceng242er9tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Anti-VEGF agents vs control in people with non-proliferative diabetic retinopathy. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng242er9tab5"><a href="/books/NBK607258/table/niceng242er9.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img" rid-ob="figobniceng242er9tab5"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng242er9.tab5"><a href="/books/NBK607258/table/niceng242er9.tab5/?report=objectonly" target="object" rid-ob="figobniceng242er9tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Intravitreal steroids vs control in people with non-proliferative diabetic retinopathy. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng242er9tab6"><a href="/books/NBK607258/table/niceng242er9.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img" rid-ob="figobniceng242er9tab6"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng242er9.tab6"><a href="/books/NBK607258/table/niceng242er9.tab6/?report=objectonly" target="object" rid-ob="figobniceng242er9tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Anti-VEGF agents vs control in people with non-proliferative diabetic retinopathy and diabetic macular oedema. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng242er9tab7"><a href="/books/NBK607258/table/niceng242er9.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img" rid-ob="figobniceng242er9tab7"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng242er9.tab7"><a href="/books/NBK607258/table/niceng242er9.tab7/?report=objectonly" target="object" rid-ob="figobniceng242er9tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Intravitreal steroids pre-surgery vs post-surgery in people with non-proliferative diabetic retinopathy and diabetic macular oedema. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng242er9tab8"><a href="/books/NBK607258/table/niceng242er9.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img" rid-ob="figobniceng242er9tab8"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng242er9.tab8"><a href="/books/NBK607258/table/niceng242er9.tab8/?report=objectonly" target="object" rid-ob="figobniceng242er9tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Intravitreal steroids vs control in people with non-proliferative diabetic retinopathy and diabetic macular oedema. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng242er9tab9"><a href="/books/NBK607258/table/niceng242er9.tab9/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img" rid-ob="figobniceng242er9tab9"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng242er9.tab9"><a href="/books/NBK607258/table/niceng242er9.tab9/?report=objectonly" target="object" rid-ob="figobniceng242er9tab9">Table 9</a></h4><p class="float-caption no_bottom_margin">Anti-VEGF agents vs intravitreal steroids in people with non-proliferative diabetic retinopathy and diabetic macular oedema. </p></div></div><p>See <a href="#niceng242er9.appf">Appendix F</a> for full GRADE and tables and <a href="#niceng242er9.appe">Appendix E</a> for forest plots.</p></div><div id="niceng242er9.s1.1.7"><h4>1.1.7. Economic evidence</h4><div id="niceng242er9.s1.1.7.1"><h5>1.1.7.1. Included studies</h5><p>A single search was performed to identify published economic evaluations of relevance to any of the questions in this guideline update (see <a href="#niceng242er9.appb">Appendix B</a>). This search retrieved 672 studies. Based on title and abstract screening, 671 of the studies could confidently be excluded for this review question. One study was excluded following the full-text review. No relevant health economic studies were included.</p></div><div id="niceng242er9.s1.1.7.2"><h5>1.1.7.2. Excluded studies</h5><p>See <a href="#niceng242er9.appj">Appendix J</a> for excluded studies and reasons for exclusion.</p><p>See the health economic study selection flow chart presented in <a href="#niceng242er9.appg">Appendix G</a>.</p></div></div><div id="niceng242er9.s1.1.8"><h4>1.1.8. Summary of included economic evidence</h4><p>No relevant health economic studies were identified to be included.</p></div><div id="niceng242er9.s1.1.9"><h4>1.1.9. Economic model</h4><p>Original health economic modelling was not conducted for this review question.</p></div><div id="niceng242er9.s1.1.10"><h4>1.1.10. Unit costs</h4><p>Costs associated with treatment are present in <a href="/books/NBK607258/table/niceng242er9.tab10/?report=objectonly" target="object" rid-ob="figobniceng242er9tab10">Table 10</a> below. It should be noted that aflibercept, ranibizumab and bevacizumab are recommended by NICE only if the manufacturer provides them with the agreed confidential patient access scheme discount.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng242er9tab10"><a href="/books/NBK607258/table/niceng242er9.tab10/?report=objectonly" target="object" title="Table 10" class="img_link icnblk_img" rid-ob="figobniceng242er9tab10"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng242er9.tab10"><a href="/books/NBK607258/table/niceng242er9.tab10/?report=objectonly" target="object" rid-ob="figobniceng242er9tab10">Table 10</a></h4><p class="float-caption no_bottom_margin">List prices of treatment alongside cataract surgery. </p></div></div></div><div id="niceng242er9.s1.1.11"><h4>1.1.11. Evidence statements</h4><p>No relevant health economic studies were identified.</p></div><div id="niceng242er9.s1.1.12"><h4>1.1.12. The committee’s discussion and interpretation of the evidence</h4><div id="niceng242er9.s1.1.12.1"><h5>1.1.12.1. The outcomes that matter most</h5><p>Both visual acuity and progression to proliferative diabetic retinopathy or macular oedema were considered important for decision making as these are the outcomes that result in the need for additional treatment and can lead to loss of vision for patients. Adverse events associated with treatment were also considered important. The committee also highlighted the importance of peripheral vision, as impairment of peripheral vision can have significant consequences, especially when it comes to activities like driving. However, no studies included in the review reported on peripheral vision outcomes. The committee wanted to consider quality of life outcomes but this was not reported in any of the studies.</p><p>The committee were also interested in information on success of cataract surgery and rates of additional intervention, but no evidence was reported for these outcomes. However, they did not think these were as important to decision-making as the vision- and progression-related outcomes.</p></div><div id="niceng242er9.s1.1.12.2"><h5>1.1.12.2. The quality of the evidence</h5><p>The evidence for the outcomes ranged from low- to high-quality, with most being moderate quality. All studies were considered fully applicable to the review. Evidence was available for people who only had non-proliferative diabetic retinopathy and people who had non-proliferative diabetic retinopathy with diabetic macular oedema. No evidence was available for people with proliferative diabetic retinopathy. The protocol specified that where no RCT evidence was available for a comparison, observational evidence would be considered instead. However, none of the observational evidence that was available for these comparisons met the inclusion criteria for the review.</p><p>The studies reported on a number of different interventions, and each study only reported a small number of outcomes. This meant that there was limited meta-analysis, with much of the evidence instead being based on single study results. This, and the small sample sizes in most of the studies, made it difficult to draw strong conclusions from the results. The committee expected more studies to report on ocular adverse events, particularly with the use of steroids. They thought that the low numbers of adverse events may be due to the way these were recorded by the studies, rather than a lack of adverse events associated with treatment. In addition, the committee discussed how the studies were not powered to show the benefits of adjuvant treatments. This made it difficult to be certain of the true effect of different interventions.</p><p>Most studies considered interventions during surgery. Only one study compared the effects of delivering an intervention before or after cataract surgery. As a result, the committee could not make any recommendations on the timing of interventions relative to cataract surgery.</p><p>The evidence considered the use of anti-VEGFs and of steroids, but there was no evidence for the use of laser photocoagulation before, during or after cataract surgery. The committee discussed how the lack of evidence for laser photocoagulation before cataract surgery is likely to be because the presence of a cataract generally means that the laser would not be able to target the correct areas of the retina, and so this is not common in clinical practice.</p><p>Given the limited evidence base, the small sample sizes, and the reliance on single studies for some comparisons, the committee decided they could not make recommendations on the most effective intervention for any of the populations. Instead, they decided that the limitations of the existing evidence meant that research recommendations were needed (see <a href="#niceng242er9.appk">Appendix K</a>). This will help to ensure that people with diabetic retinopathy or diabetic macular oedema receive the most effective treatments in future.</p></div><div id="niceng242er9.s1.1.12.3"><h5>1.1.12.3. Imprecision and clinical importance of effects</h5><p>The reliance on single study results for many outcomes and the small number of eyes included in some of the studies resulted in wide confidence intervals which crossed the line of no effect for much of the evidence. This made it difficult for the committee to be certain of the true effect of different interventions. It emphasises the need for more comprehensive studies with larger sample sizes to obtain more precise estimates of treatment effects.</p><p>Most of the evidence could not differentiate between different interventions, but the committee thought that this was partly due to the limited evidence base, supporting the need for the research recommendations. There was evidence that visual acuity improved with anti-VEGFs compared to control for people with non-proliferative retinopathy and for people with non-proliferative retinopathy with diabetic macular oedema. However, the committee highlighted that the difference for people with non-proliferative retinopathy was not clinically meaningful. Although the result for people with non-proliferative retinopathy with macular oedema was clinically meaningful, it was based off the result of a single study with a small sample size, which did not report the dose used for bevacizumab. It was therefore difficult to make any recommendations from this result.</p></div><div id="niceng242er9.s1.1.12.4"><h5>1.1.12.4. Benefits and harms</h5><p>The limited number of studies, small sample sizes and wide confidence intervals made it difficult for the committee to be confident of the benefits and harms of each treatment. There was some evidence that anti-VEGFs improved visual acuity compared to control for people with non-proliferative diabetic retinopathy with macular oedema. However, no information was provided on the other outcomes, including adverse events. This made it difficult to be certain of the effectiveness of anti-VEGFs for this group.</p><p>There was no clear difference in effectiveness between the use of steroids and either control or anti-VEGFs. One study showed that steroids can result in a reduced number of treatments, but this was not accompanied by improvements in visual acuity. The committee also discussed the lack of evidence for adverse events, and the limited number of adverse events when they were reported. The committee thought this was likely to be related to how the studies reported the events, rather than a lack of events, as steroids are commonly associated with a higher rate of adverse events. As a result, the committee did not think they could make recommendations on the use of either anti-VEGFs or steroids for people who have non-proliferative diabetic retinopathy with diabetic macular oedema.</p><p>The committee emphasised that their decision to not make recommendations is not due to a perceived lack of effectiveness of different interventions, but due to the limited amount of evidence. For this reason, they made research recommendations for people with non-proliferative diabetic retinopathy and for people with diabetic macular oedema (see <a href="#niceng242er9.appk">Appendix K</a>). The committee thought these were important research topics, as preventing, or slowing, progression will reduce the number of additional treatments that people may otherwise need if they develop proliferative diabetic retinopathy or have further progression of their macular oedema. It will also reduce the number of people who develop more serious outcomes, such as vision loss, which is a major concern to people who have retinopathy. In addition to benefits to patients, an understanding of the most effective treatments will reduce the resources needed to treat people who have progressed.</p><p>The committee were aware of recommendations about managing complications associated with cataract surgery in the <a href="https://www.nice.org.uk/guidance/ng77/chapter/Recommendations#preventing-and-managing-complications" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE cataracts guideline</a> about the use of steroids and NSAIDs to manage complications relating to cystoid macular oedema. These recommendations are related to people who are at increased risk of cystoid macular oedema following cataract surgery, including those with diabetes. The committee thought that this information was relevant to the diabetic retinopathy guideline and were not aware of any major changes to the evidence base since the cataract guideline was published. The population that informed the recommendations in the cataract’s guideline included a subgroup specifically for people with diabetic retinopathy, and so the committee decided that this was relevant to the diabetic retinopathy guideline and should be highlighted in the recommendations.</p></div><div id="niceng242er9.s1.1.12.5"><h5>1.1.12.5. Cost-effectiveness and resource use</h5><p>No relevant economic evaluations were identified which addressed the cost-effectiveness of treatments before, during or after cataract surgery for managing non-proliferative diabetic retinopathy, proliferative diabetic retinopathy, and diabetic macular oedema. The committee felt more evidence was required to be able to make recommendations on the effectiveness and cost-effectiveness of treatments before, during and after surgery in people with moderate to severe non-proliferative diabetic retinopathy, proliferative diabetic retinopathy, or diabetic macular oedema. As such, the committee proposed recommendations for future research to ensure no unnecessary resource impact is made without any clinical evidence.</p><p>To ensure people with diabetes who are having cataract surgery are treated correctly, the committee felt it was important the surgeon undertaking the surgery should be aware of their current diabetic eye disease status. The committee did not anticipate this would have any resource impact because it is simply ensuring information is being shared correctly rather than requiring any additional resources for treatment or monitoring.</p><p>The committee discussed that anti-VEGFs should be considered as temporary treatment for people who have proliferative diabetic retinopathy and for whom PRP is not suitable because they need cataract surgery. Whilst there was very limited evidence for this recommendation, the committee did not expect there to be a large resource impact because anti-VEGFs would only be expected to be used for short term treatment such as 1 to 2 injections to prevent progression whilst waiting for cataract treatment. The committee felt that the resources saved by reduced progression whilst waiting for cataract surgery would offset the increase in short term costs associated with anti-VEGF treatments. The committee anticipated that the resource impact would be further managed if either bevacizumab or the cheapest available anti-VEGF which is licensed for the treatment of proliferative diabetic retinopathy such as biosimilars were to be the preferred treatment option, because there was limited evidence for differences in clinical effectiveness between the anti-VEGF treatments.</p></div><div id="niceng242er9.s1.1.12.6"><h5>1.1.12.6. Other factors the committee took into account</h5><p>There was no evidence on the use of different services, such as independent centres, for cataract surgery. The committee discussed how many people are now treated for cataracts in independent centres, rather than by NHS services. They thought it was important to highlight that, in their experience, the use of these centres can lead to complications for some people. This is because these people’s current retinopathy status is not always identified before cataract surgery. Without this information, surgery may not always be tailored to a person’s eye condition, or they may not be given the most effective post-operative medication or follow-up care. The committee therefore decided to recommend that surgeons who are performing cataract surgery should obtain information about a person’s retinopathy status prior to surgery. They noted that this information can be identified from a number of sources, such as the NHS diabetic eye screening programme, the Hospital Eye Services medical retina clinic or by examination of the retina.</p></div></div><div id="niceng242er9.s1.1.13"><h4>1.1.13. Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.2.1 to 1.2.2 and the research recommendations for people with moderate to severe non-proliferative diabetic retinopathy, who are about to undergo or who have undergone cataract surgery and people with diabetic macular oedema, who are about to undergo or who have undergone cataract surgery.</p></div><div id="niceng242er9.s1.1.rl.r1"><h4>1.1.14. References – included studies</h4><ul class="simple-list"><div id="niceng242er9.s1.1.rl.r1.1"><h5>1.1.14.1. Effectiveness</h5><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng242er9.s1.1.ref1">Ahmadabadi, Hooshang Faghihi, Mohammadi, Massood, Beheshtnejad, Hooshang
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et al. (2010) Effect of intravitreal triamcinolone acetonide injection on central macular thickness in diabetic patients having phacoemulsification. Journal of cataract and refractive surgery
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36(6): 917–22
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[<a href="https://pubmed.ncbi.nlm.nih.gov/20494761" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20494761</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng242er9.s1.1.ref2">Barone, Antonio, Russo, Vincenzo, Maggiore, Giulia
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et al. (2022) Dexamethasone intravitreal implant in patients with cataract and naive diabetic macular edema. European journal of ophthalmology
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32(1): 364–371
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[<a href="https://pubmed.ncbi.nlm.nih.gov/33757366" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33757366</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng242er9.s1.1.ref3">Chae, Ju Byung, Joe, Soo Geun, Yang, Sung Jae
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et al. (2014) Effect of combined cataract surgery and ranibizumab injection in postoperative macular edema in nonproliferative diabetic retinopathy. Retina (Philadelphia, Pa.)
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34(1): 149–56
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[<a href="https://pubmed.ncbi.nlm.nih.gov/23807186" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23807186</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng242er9.s1.1.ref4">Fard, Masoud Aghsaei; Yazdanei Abyane, Alireza; Malihi, Mehrdad (2011) Prophylactic intravitreal bevacizumab for diabetic macular edema (thickening) after cataract surgery: prospective randomized study. European journal of ophthalmology
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21(3): 276–81
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[<a href="https://pubmed.ncbi.nlm.nih.gov/20853269" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20853269</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng242er9.s1.1.ref5">Gupta, Parul Chawla, Ram, Jagat, Kumar, M Praveen
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et al. (2021) Effect of sustained-release long-acting intravitreal dexamethasone implant in patients of non-proliferative diabetic retinopathy undergoing phacoemulsification: A randomized controlled trial. Indian journal of ophthalmology
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69(11): 3263–3272
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[<a href="/pmc/articles/PMC8725102/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8725102</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34708785" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34708785</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng242er9.s1.1.ref6">Kandasamy, Rathika, Constantinou, Marios, Rogers, Sophie L
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et al. (2019) Prospective randomised clinical trial of intravitreal bevacizumab versus triamcinolone in eyes with diabetic macular oedema undergoing cataract surgery: 6-month results. The British journal of ophthalmology
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103(12): 1753–1758
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[<a href="https://pubmed.ncbi.nlm.nih.gov/30819688" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30819688</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng242er9.s1.1.ref7">Lanzagorta-Aresti, Aitor, Palacios-Pozo, Elena, Menezo Rozalen, Jose Luis
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et al. (2009) Prevention of vision loss after cataract surgery in diabetic macular edema with intravitreal bevacizumab: a pilot study. Retina (Philadelphia, Pa.)
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29(4): 530–5
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[<a href="https://pubmed.ncbi.nlm.nih.gov/19357559" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19357559</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng242er9.s1.1.ref8">Sasongko, Muhammad B, Rogers, Sophie, Constantinou, Marios
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et al. (2020) Diabetic retinopathy progression 6 months post-cataract surgery with intravitreous bevacizumab vs triamcinolone: A secondary analysis of the DiMECAT trial. Clinical & experimental ophthalmology
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48(6): 793–801
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[<a href="https://pubmed.ncbi.nlm.nih.gov/32356581" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32356581</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng242er9.s1.1.ref9">Song, Weilin, Conti, Thais F, Gans, Richard
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et al. (2020) Prevention of Macular Edema in Patients With Diabetic Retinopathy Undergoing Cataract Surgery: The PROMISE Trial. Ophthalmic surgery, lasers & imaging retina
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51(3): 170–178 [<a href="https://pubmed.ncbi.nlm.nih.gov/32211907" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32211907</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng242er9.s1.1.ref10">Takamura, Yoshihiro; Kubo, Eri; Akagi, Yoshio (2009) Analysis of the effect of intravitreal bevacizumab injection on diabetic macular edema after cataract surgery. Ophthalmology
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116(6): 1151–7
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[<a href="https://pubmed.ncbi.nlm.nih.gov/19376589" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19376589</span></a>]</div></p></li></ul></div><div id="niceng242er9.s1.1.rl.r1.2"><h5>1.1.14.2. Economic</h5><ul class="simple-list"><p>No economic studies were included. The following unit cost references have been included.</p><li class="half_rhythm"><p><div class="bk_ref" id="niceng242er9.s1.1.ref11">National Institute for Health and Care Excellence (NICE). BNF. 2019. Available from: <a href="https://bnf.nice.org.uk/drug/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://bnf<wbr style="display:inline-block"></wbr>​.nice.org.uk/drug/</a></div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng242er9.s1.1.ref12">National Institute for Health and Care Excellence (NICE). TA824 Dexamethasone intravitreal implant for treating diabetic macular oedema. 2022. Available from <a href="https://www.nice.org.uk/guidance/ta824" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.nice.org.uk/guidance/ta824</a></div></p></li></ul></div><div id="niceng242er9.s1.1.rl.r1.3"><h5>1.1.14.3. Other</h5><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng242er9.s1.1.ref13">Poku
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E, Rathbone
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J, Everson-Hock
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E, Essat
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M, Wong
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R, Pandor
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A, Wailoo
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AJ. (2012) Bevacizumab in eye conditions: Issues related to quality, use, efficacy and safety. NICE Decision Support Unit Report.</div></p></li></ul></div></ul></div></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng242er9.appa"><h3>Appendix A. Review protocols</h3><p id="niceng242er9.appa.et1"><a href="/books/NBK607258/bin/niceng242er9-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (231K)</span></p></div><div id="niceng242er9.appb"><h3>Appendix B. Literature search strategies</h3><div id="niceng242er9.appb.s1"><h4>Search design and peer review</h4><p>NICE information specialists conducted the literature searches for the evidence review. The searches were run in November 2022. Update searches were run in Feb 2023. This search report is compliant with the requirements of PRISMA-S.</p><p>The MEDLINE strategy below was quality assured (QA) by a trained NICE information specialist. All translated search strategies were peer reviewed to ensure their accuracy. Both procedures were adapted from the 2016 PRESS Checklist.</p><p>The principal search strategy was developed in MEDLINE (Ovid interface) and adapted, as appropriate, for use in the other sources listed in the protocol, taking into account their size, search functionality and subject coverage.</p></div><div id="niceng242er9.appb.s2"><h4>Review Management</h4><p>The search results were managed in EPPI-Reviewer v5. Duplicates were removed in EPPI-R5 using a two-step process. First, automated deduplication is performed using a high-value algorithm. Second, manual deduplication is used to assess ‘low-probability’ matches. All decisions made for the review can be accessed via the deduplication history.</p></div><div id="niceng242er9.appb.s3"><h4>Limits and restrictions</h4><p>English language limits were applied in adherence to standard NICE practice and the review protocol.</p><p>Limits to exclude, conference abstract or conference paper or “conference review” were applied in adherence to standard NICE practice and the review protocol. The limit to remove animal studies in the searches was the standard NICE practice, which has been adapted from: Dickersin, K., Scherer, R., & Lefebvre, C. (1994). Systematic Reviews: Identifying relevant studies for systematic reviews. BMJ, 309(6964), 1286
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[<a href="/pmc/articles/PMC2541778/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2541778</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/7718048" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7718048</span></a>].</p></div><div id="niceng242er9.appb.s4"><h4>Search filters</h4><p id="niceng242er9.appb.et1"><a href="/books/NBK607258/bin/niceng242er9-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (235K)</span></p></div><div id="niceng242er9.appb.s5"><h4>Limits and restrictions</h4><p>English language limits were applied in adherence to standard NICE practice and the review protocol.</p><p>Limits to exclude, comment or letter or editorial or historical articles or conference abstract or conference paper or “conference review” or letter or case report were applied in adherence to standard NICE practice and the review protocol.</p><p>The limit to remove animal studies in the searches was the standard NICE practice, which has been adapted from: Dickersin, K., Scherer, R., & Lefebvre, C. (1994). Systematic Reviews: Identifying relevant studies for systematic reviews. BMJ, 309(6964), 1286
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[<a href="/pmc/articles/PMC2541778/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2541778</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/7718048" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7718048</span></a>].</p></div><div id="niceng242er9.appb.s6"><h4>Search filters</h4><p id="niceng242er9.appb.et2"><a href="/books/NBK607258/bin/niceng242er9-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (226K)</span></p></div></div><div id="niceng242er9.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng242er9.appc.et1"><a href="/books/NBK607258/bin/niceng242er9-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (105K)</span></p></div><div id="niceng242er9.appd"><h3>Appendix D. Effectiveness evidence</h3><p id="niceng242er9.appd.et1"><a href="/books/NBK607258/bin/niceng242er9-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (348K)</span></p></div><div id="niceng242er9.appe"><h3>Appendix E. Forest plots</h3><div id="niceng242er9.appe.s1"><h4>E.1.1. Anti-VEGF agents vs control in people with non-proliferative diabetic retinopathy</h4><p id="niceng242er9.appe.et1"><a href="/books/NBK607258/bin/niceng242er9-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (124K)</span></p></div><div id="niceng242er9.appe.s2"><h4>E.1.2. Intravitreal steroids vs control in people with non-proliferative diabetic retinopathy</h4><p id="niceng242er9.appe.et2"><a href="/books/NBK607258/bin/niceng242er9-appe-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (118K)</span></p></div><div id="niceng242er9.appe.s3"><h4>E.1.3. Anti-VEGF agents vs control in people with non-proliferative diabetic retinopathy and diabetic macular oedema</h4><p id="niceng242er9.appe.et3"><a href="/books/NBK607258/bin/niceng242er9-appe-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (101K)</span></p></div><div id="niceng242er9.appe.s4"><h4>E.1.4. Anti-VEGF agents vs control in people with non-proliferative diabetic retinopathy and diabetic macular oedema</h4><p><a class="bibr" href="#niceng242er9.s1.1.ref10" rid="niceng242er9.s1.1.ref10">Takamura 2009</a> reported that there were no adverse events (severe ocular inflammation; significant increase of IOP) in any of the participating eyes. Therefore, effect estimate could not be calculated.</p></div><div id="niceng242er9.appe.s5"><h4>E.1.5. Intravitreal steroids pre-surgery vs post-surgery in people with non-proliferative diabetic retinopathy and diabetic macular oedema</h4><p id="niceng242er9.appe.et4"><a href="/books/NBK607258/bin/niceng242er9-appe-et4.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (101K)</span></p></div><div id="niceng242er9.appe.s6"><h4>E.1.6. Intravitreal steroids vs control in people with non-proliferative diabetic retinopathy and diabetic macular oedema</h4><p id="niceng242er9.appe.et5"><a href="/books/NBK607258/bin/niceng242er9-appe-et5.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (101K)</span></p></div><div id="niceng242er9.appe.s7"><h4>E.1.7. Anti-VEGF agents vs intravitreal steroids in people with non-proliferative diabetic retinopathy and diabetic macular oedema</h4><p id="niceng242er9.appe.et6"><a href="/books/NBK607258/bin/niceng242er9-appe-et6.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (120K)</span></p></div></div><div id="niceng242er9.appf"><h3>Appendix F. GRADE tables</h3><p id="niceng242er9.appf.et1"><a href="/books/NBK607258/bin/niceng242er9-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">F.1.1. Anti-VEGF agents vs control in people with non-proliferative diabetic retinopathy</a><span class="small"> (PDF, 106K)</span></p><p id="niceng242er9.appf.et2"><a href="/books/NBK607258/bin/niceng242er9-appf-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">F.1.2. Intravitreal steroids vs control in people with non-proliferative diabetic retinopathy</a><span class="small"> (PDF, 108K)</span></p><p id="niceng242er9.appf.et3"><a href="/books/NBK607258/bin/niceng242er9-appf-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">F.1.3. Anti-VEGF agents vs control in people with non-proliferative diabetic retinopathy and diabetic macular oedema</a><span class="small"> (PDF, 101K)</span></p><p id="niceng242er9.appf.et4"><a href="/books/NBK607258/bin/niceng242er9-appf-et4.pdf" class="bk_dwnld_icn bk_dwnld_pdf">F.1.4. Intravitreal steroids pre-surgery vs post-surgery in people with non-proliferative diabetic retinopathy and diabetic macular oedema</a><span class="small"> (PDF, 101K)</span></p><p id="niceng242er9.appf.et5"><a href="/books/NBK607258/bin/niceng242er9-appf-et5.pdf" class="bk_dwnld_icn bk_dwnld_pdf">F.1.5. Intravitreal steroids vs control in people with non-proliferative diabetic retinopathy and diabetic macular oedema</a><span class="small"> (PDF, 101K)</span></p><p id="niceng242er9.appf.et6"><a href="/books/NBK607258/bin/niceng242er9-appf-et6.pdf" class="bk_dwnld_icn bk_dwnld_pdf">F.1.6. Anti-VEGF agents vs intravitreal steroids in people with non-proliferative diabetic retinopathy and diabetic macular oedema</a><span class="small"> (PDF, 107K)</span></p></div><div id="niceng242er9.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng242er9.appg.et1"><a href="/books/NBK607258/bin/niceng242er9-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (106K)</span></p></div><div id="niceng242er9.apph"><h3>Appendix H. Economic evidence tables</h3><p>There are no included studies for this review question.</p></div><div id="niceng242er9.appi"><h3>Appendix I. Health economic model</h3><p>Original health economic modelling has not been conducted for this review question.</p></div><div id="niceng242er9.appj"><h3>Appendix J. Excluded studies</h3><div id="niceng242er9.appj.s1"><h4>Clinical evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng242er9appjtab1"><a href="/books/NBK607258/table/niceng242er9.appj.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobniceng242er9appjtab1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng242er9.appj.tab1"><a href="/books/NBK607258/table/niceng242er9.appj.tab1/?report=objectonly" target="object" rid-ob="figobniceng242er9appjtab1">Table</a></h4><p class="float-caption no_bottom_margin">- Mixed population. Outcomes not reported by relevant subgroups
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<i>Includes people with non-proliferative retinopathy, proliferative retinopathy and with or without macular oedema. Results not reported separately</i>
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</p></div></div></div><div id="niceng242er9.appj.s2"><h4>Economic evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng242er9appjtab2"><a href="/books/NBK607258/table/niceng242er9.appj.tab2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobniceng242er9appjtab2"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng242er9.appj.tab2"><a href="/books/NBK607258/table/niceng242er9.appj.tab2/?report=objectonly" target="object" rid-ob="figobniceng242er9appjtab2">Table</a></h4></div></div></div></div><div id="niceng242er9.appk"><h3>Appendix K. Research recommendations – full details</h3><p id="niceng242er9.appk.et1"><a href="/books/NBK607258/bin/niceng242er9-appk-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">K.1.1. Research recommendation</a><span class="small"> (PDF, 138K)</span></p><p id="niceng242er9.appk.et2"><a href="/books/NBK607258/bin/niceng242er9-appk-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">K.1.2. Research recommendation</a><span class="small"> (PDF, 138K)</span></p></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence reviews underpinning recommendations 1.2.1 and 1.2.2, and research recommendations 10 and 11 in the NICE guideline</p><p>These evidence reviews were developed by NICE</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2024.</div><div class="small"><span class="label">Bookshelf ID: NBK607258</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/39288240" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">39288240</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng242er9tab1"><div id="niceng242er9.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Effectiveness of treatments before, during or after cataract surgery for managing non-proliferative diabetic retinopathy, proliferative diabetic retinopathy or diabetic macular oedema</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK607258/table/niceng242er9.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng242er9.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng242er9.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><td headers="hd_b_niceng242er9.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">People diagnosed with:
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<ul><li class="half_rhythm"><div>non-proliferative diabetic retinopathy</div></li><li class="half_rhythm"><div>proliferative diabetic retinopathy</div></li><li class="half_rhythm"><div>diabetic macular oedema</div></li></ul>
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who are about to undergo or who have undergone cataract surgery</td></tr><tr><th id="hd_b_niceng242er9.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_niceng242er9.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Laser photocoagulation</div></li><li class="half_rhythm"><div>Anti-VEGF agents</div></li><li class="half_rhythm"><div>Intravitreal steroids (before during or after cataract surgery) including subconjunctival steroids (dexamethasone and triamcinolone)</div></li></ul>
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</td></tr><tr><th id="hd_b_niceng242er9.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Comparator</th><td headers="hd_b_niceng242er9.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Laser photocoagulation</div></li><li class="half_rhythm"><div>Anti-VEGF agents</div></li><li class="half_rhythm"><div>Intravitreal steroids</div></li><li class="half_rhythm"><div>No treatment/placebo</div></li><li class="half_rhythm"><div>Studies comparing treatments before during or after cataract surgery will be included.</div></li></ul>
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</td></tr><tr><th id="hd_b_niceng242er9.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng242er9.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><b>Primary:</b>
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<ul><li class="half_rhythm"><div>Best corrected visual acuity
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<ul class="circle"><li class="half_rhythm"><div>Best correct visual acuity will be presented per eye when this data is available in the study</div></li><li class="half_rhythm"><div>Per patient data will only be extracted when this data is not presented in a study.</div></li></ul></div></li><li class="half_rhythm"><div>Progression to or of proliferative diabetic retinopathy or macular oedema</div></li></ul>
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<b>Secondary:</b>
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<ul><li class="half_rhythm"><div>Success of cataract surgery</div></li><li class="half_rhythm"><div>Rates of additional intervention</div></li><li class="half_rhythm"><div>Adverse events (Raised intraocular pressure, Intraocular infection, Intraocular Inflammation)</div></li><li class="half_rhythm"><div>Quality of life</div></li><li class="half_rhythm"><div>Peripheral vision, assessed using visual field measurements</div></li></ul>
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Outcomes will be reported at the latest time point reported by the study. Reporting at earlier timepoints will be considered to facilitate meta-analysis or where dropout means that earlier timepoints are associated with substantially more precision</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng242er9tab2"><div id="niceng242er9.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Table of included studies: People with non-proliferative diabetic retinopathy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK607258/table/niceng242er9.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng242er9.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng242er9.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Longest Follow-up time</th><th id="hd_h_niceng242er9.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_niceng242er9.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_niceng242er9.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator</th><th id="hd_h_niceng242er9.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th></tr></thead><tbody><tr><th headers="hd_h_niceng242er9.tab2_1_1_1_1 hd_h_niceng242er9.tab2_1_1_1_2 hd_h_niceng242er9.tab2_1_1_1_3 hd_h_niceng242er9.tab2_1_1_1_4 hd_h_niceng242er9.tab2_1_1_1_5 hd_h_niceng242er9.tab2_1_1_1_6" id="hd_b_niceng242er9.tab2_1_1_1_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">Anti-VEGFs vs control: During surgery</th></tr><tr><td headers="hd_h_niceng242er9.tab2_1_1_1_1 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
<p><a class="bibr" href="#niceng242er9.s1.1.ref9" rid="niceng242er9.s1.1.ref9">Song 2020</a> (PROMISE)</p>
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<p>USA</p>
|
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<p>n=30 eyes</p>
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|
</td><td headers="hd_h_niceng242er9.tab2_1_1_1_2 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">90 days</td><td headers="hd_h_niceng242er9.tab2_1_1_1_3 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type 1 or type 2 diabetes and non-proliferative diabetic retinopathy or inactive proliferative diabetic retinopathy without clinically significant macular oedema</td><td headers="hd_h_niceng242er9.tab2_1_1_1_4 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with 2 mg intravitreal aflibercept injection</td><td headers="hd_h_niceng242er9.tab2_1_1_1_5 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with sham injection</td><td headers="hd_h_niceng242er9.tab2_1_1_1_6 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Best corrected visual acuity</div></li><li class="half_rhythm"><div>Progression to macular oedema</div></li><li class="half_rhythm"><div>Adverse events (number of ocular treatment-related adverse events)</div></li></ul>
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|
</td></tr><tr><td headers="hd_h_niceng242er9.tab2_1_1_1_1 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng242er9.s1.1.ref3" rid="niceng242er9.s1.1.ref3">Chae 2014</a>
|
|
</p>
|
|
<p>Korea</p>
|
|
<p>n=80 eyes</p>
|
|
</td><td headers="hd_h_niceng242er9.tab2_1_1_1_2 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 months</td><td headers="hd_h_niceng242er9.tab2_1_1_1_3 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People aged over 18 years with type 1 or type 2 diabetes and non-proliferative diabetic retinopathy or stable diabetic retinopathy</td><td headers="hd_h_niceng242er9.tab2_1_1_1_4 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with 0.5 mg ranibizumab injection</td><td headers="hd_h_niceng242er9.tab2_1_1_1_5 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with sham injection</td><td headers="hd_h_niceng242er9.tab2_1_1_1_6 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
<ul><li class="half_rhythm"><div>Best corrected visual acuity</div></li><li class="half_rhythm"><div>Progression to macular oedema</div></li></ul>
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|
</td></tr><tr><td headers="hd_h_niceng242er9.tab2_1_1_1_1 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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|
<p>
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<a class="bibr" href="#niceng242er9.s1.1.ref4" rid="niceng242er9.s1.1.ref4">Fard 2011</a>
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</p>
|
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<p>Iran</p>
|
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<p>n=61 eyes</p>
|
|
</td><td headers="hd_h_niceng242er9.tab2_1_1_1_2 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 months</td><td headers="hd_h_niceng242er9.tab2_1_1_1_3 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with diabetes and moderate or severe non-proliferative diabetic retinopathy</td><td headers="hd_h_niceng242er9.tab2_1_1_1_4 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with 1.25 mg bevacizumab injection</td><td headers="hd_h_niceng242er9.tab2_1_1_1_5 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery alone (control)</td><td headers="hd_h_niceng242er9.tab2_1_1_1_6 hd_b_niceng242er9.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Best corrected visual acuity</div></li><li class="half_rhythm"><div>Progression of diabetic retinopathy</div></li><li class="half_rhythm"><div>Adverse events (number of ocular treatment-related adverse events)</div></li></ul>
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</td></tr><tr><th headers="hd_h_niceng242er9.tab2_1_1_1_1 hd_h_niceng242er9.tab2_1_1_1_2 hd_h_niceng242er9.tab2_1_1_1_3 hd_h_niceng242er9.tab2_1_1_1_4 hd_h_niceng242er9.tab2_1_1_1_5 hd_h_niceng242er9.tab2_1_1_1_6" id="hd_b_niceng242er9.tab2_1_1_5_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">Steroids vs control: During surgery</th></tr><tr><td headers="hd_h_niceng242er9.tab2_1_1_1_1 hd_b_niceng242er9.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng242er9.s1.1.ref5" rid="niceng242er9.s1.1.ref5">Gupta 2021</a>
|
|
</p>
|
|
<p>India</p>
|
|
<p>n=151 eyes (subgroup from main analysis)</p>
|
|
</td><td headers="hd_h_niceng242er9.tab2_1_1_1_2 hd_b_niceng242er9.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 weeks</td><td headers="hd_h_niceng242er9.tab2_1_1_1_3 hd_b_niceng242er9.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People aged greater than 30 years with type 2 diabetes and mild/moderate/severe non-proliferative diabetic retinopathy, with or without diabetic macular oedema</td><td headers="hd_h_niceng242er9.tab2_1_1_1_4 hd_b_niceng242er9.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with 0.7 mg dexamethasone drug delivery system via injection</td><td headers="hd_h_niceng242er9.tab2_1_1_1_5 hd_b_niceng242er9.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery alone (control)</td><td headers="hd_h_niceng242er9.tab2_1_1_1_6 hd_b_niceng242er9.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Rates of additional intervention (number needing rescue treatments)</div></li></ul>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.tab2_1_1_1_1 hd_b_niceng242er9.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng242er9.s1.1.ref1" rid="niceng242er9.s1.1.ref1">Ahmadabadi 2010</a>
|
|
</p>
|
|
<p>Iran</p>
|
|
<p>n=41 eyes</p>
|
|
</td><td headers="hd_h_niceng242er9.tab2_1_1_1_2 hd_b_niceng242er9.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 months</td><td headers="hd_h_niceng242er9.tab2_1_1_1_3 hd_b_niceng242er9.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with type 2 diabetes and moderate non-proliferative diabetic retinopathy</td><td headers="hd_h_niceng242er9.tab2_1_1_1_4 hd_b_niceng242er9.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with 2 mg triamcinolone injection</td><td headers="hd_h_niceng242er9.tab2_1_1_1_5 hd_b_niceng242er9.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery alone (control)</td><td headers="hd_h_niceng242er9.tab2_1_1_1_6 hd_b_niceng242er9.tab2_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Best corrected visual acuity</div></li><li class="half_rhythm"><div>Progression of severe non-proliferative diabetic retinopathy</div></li><li class="half_rhythm"><div>Progression of macular oedema</div></li><li class="half_rhythm"><div>Adverse events (number with raised intra-ocular pressure)</div></li></ul>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng242er9tab3"><div id="niceng242er9.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Table of included studies: People with non-proliferative diabetic retinopathy with diabetic macular oedema</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK607258/table/niceng242er9.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng242er9.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_niceng242er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng242er9.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Longest Follow-up time</th><th id="hd_h_niceng242er9.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_niceng242er9.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><th id="hd_h_niceng242er9.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparator</th><th id="hd_h_niceng242er9.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th></tr></thead><tbody><tr><th headers="hd_h_niceng242er9.tab3_1_1_1_1 hd_h_niceng242er9.tab3_1_1_1_2 hd_h_niceng242er9.tab3_1_1_1_3 hd_h_niceng242er9.tab3_1_1_1_4 hd_h_niceng242er9.tab3_1_1_1_5 hd_h_niceng242er9.tab3_1_1_1_6" id="hd_b_niceng242er9.tab3_1_1_1_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">Anti-VEGFs vs control: During surgery</th></tr><tr><td headers="hd_h_niceng242er9.tab3_1_1_1_1 hd_b_niceng242er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng242er9.s1.1.ref10" rid="niceng242er9.s1.1.ref10">Takamura 2009</a>
|
|
</p>
|
|
<p>Japan</p>
|
|
<p>n=42 eyes</p>
|
|
</td><td headers="hd_h_niceng242er9.tab3_1_1_1_2 hd_b_niceng242er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 months</td><td headers="hd_h_niceng242er9.tab3_1_1_1_3 hd_b_niceng242er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>People with type 2 diabetes</p>
|
|
<p>Non proliferative diabetic retinopathy with diabetic macular oedema</p>
|
|
</td><td headers="hd_h_niceng242er9.tab3_1_1_1_4 hd_b_niceng242er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with 1.25 mg bevacizumab injection</td><td headers="hd_h_niceng242er9.tab3_1_1_1_5 hd_b_niceng242er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery alone (control)</td><td headers="hd_h_niceng242er9.tab3_1_1_1_6 hd_b_niceng242er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adverse events:
|
|
<ul><li class="half_rhythm"><div>Number with increased intraocular pressure</div></li><li class="half_rhythm"><div>Number with intraocular inflammation</div></li></ul></td></tr><tr><td headers="hd_h_niceng242er9.tab3_1_1_1_1 hd_b_niceng242er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng242er9.s1.1.ref7" rid="niceng242er9.s1.1.ref7">Lagzagorta-Aresti 2009</a>
|
|
</p>
|
|
<p>Spain</p>
|
|
<p>n=26 eyes</p>
|
|
</td><td headers="hd_h_niceng242er9.tab3_1_1_1_2 hd_b_niceng242er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 months</td><td headers="hd_h_niceng242er9.tab3_1_1_1_3 hd_b_niceng242er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with type 2 diabetes with moderate non-proliferative diabetic retinopathy associated with diffuse macular oedema affecting the foveal center</td><td headers="hd_h_niceng242er9.tab3_1_1_1_4 hd_b_niceng242er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with bevacizumab injection (dose not reported)</td><td headers="hd_h_niceng242er9.tab3_1_1_1_5 hd_b_niceng242er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with saline solution injection</td><td headers="hd_h_niceng242er9.tab3_1_1_1_6 hd_b_niceng242er9.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Best corrected visual acuity</div></li></ul>
|
|
</td></tr><tr><th headers="hd_h_niceng242er9.tab3_1_1_1_1 hd_h_niceng242er9.tab3_1_1_1_2 hd_h_niceng242er9.tab3_1_1_1_3 hd_h_niceng242er9.tab3_1_1_1_4 hd_h_niceng242er9.tab3_1_1_1_5 hd_h_niceng242er9.tab3_1_1_1_6" id="hd_b_niceng242er9.tab3_1_1_4_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">Steroids vs control: Pre-surgery vs post-surgery</th></tr><tr><td headers="hd_h_niceng242er9.tab3_1_1_1_1 hd_b_niceng242er9.tab3_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng242er9.s1.1.ref2" rid="niceng242er9.s1.1.ref2">Barone 2022</a>
|
|
</p>
|
|
<p>Italy</p>
|
|
<p>n=40 eyes</p>
|
|
</td><td headers="hd_h_niceng242er9.tab3_1_1_1_2 hd_b_niceng242er9.tab3_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20 weeks</td><td headers="hd_h_niceng242er9.tab3_1_1_1_3 hd_b_niceng242er9.tab3_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with non-proliferative diabetic retinopathy and clinically significant naïve macular oedema</td><td headers="hd_h_niceng242er9.tab3_1_1_1_4 hd_b_niceng242er9.tab3_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with 0.7 mg dexamethasone implant administered preoperatively</td><td headers="hd_h_niceng242er9.tab3_1_1_1_5 hd_b_niceng242er9.tab3_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with 0.7 mg dexamethasone implant administered postoperatively</td><td headers="hd_h_niceng242er9.tab3_1_1_1_6 hd_b_niceng242er9.tab3_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Best corrected visual acuity</div></li></ul>
|
|
</td></tr><tr><th headers="hd_h_niceng242er9.tab3_1_1_1_1 hd_h_niceng242er9.tab3_1_1_1_2 hd_h_niceng242er9.tab3_1_1_1_3 hd_h_niceng242er9.tab3_1_1_1_4 hd_h_niceng242er9.tab3_1_1_1_5 hd_h_niceng242er9.tab3_1_1_1_6" id="hd_b_niceng242er9.tab3_1_1_6_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">Steroids vs control: During surgery</th></tr><tr><td headers="hd_h_niceng242er9.tab3_1_1_1_1 hd_b_niceng242er9.tab3_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<a class="bibr" href="#niceng242er9.s1.1.ref5" rid="niceng242er9.s1.1.ref5">Gupta 2021</a>
|
|
</p>
|
|
<p>India</p>
|
|
<p>n=151 eyes (subgroup from main analysis)</p>
|
|
</td><td headers="hd_h_niceng242er9.tab3_1_1_1_2 hd_b_niceng242er9.tab3_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 weeks</td><td headers="hd_h_niceng242er9.tab3_1_1_1_3 hd_b_niceng242er9.tab3_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People aged greater than 30 years with type 2 diabetes and mild/moderate/severe non-proliferative diabetic retinopathy, with or without diabetic macular oedema</td><td headers="hd_h_niceng242er9.tab3_1_1_1_4 hd_b_niceng242er9.tab3_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with 0.7 mg dexamethasone drug delivery system via injection</td><td headers="hd_h_niceng242er9.tab3_1_1_1_5 hd_b_niceng242er9.tab3_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery alone (control)</td><td headers="hd_h_niceng242er9.tab3_1_1_1_6 hd_b_niceng242er9.tab3_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Rates of additional intervention (number needing rescue treatments)</div></li></ul>
|
|
</td></tr><tr><th headers="hd_h_niceng242er9.tab3_1_1_1_1 hd_h_niceng242er9.tab3_1_1_1_2 hd_h_niceng242er9.tab3_1_1_1_3 hd_h_niceng242er9.tab3_1_1_1_4 hd_h_niceng242er9.tab3_1_1_1_5 hd_h_niceng242er9.tab3_1_1_1_6" id="hd_b_niceng242er9.tab3_1_1_8_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">Anti-VEGFs vs steroids: During surgery</th></tr><tr><td headers="hd_h_niceng242er9.tab3_1_1_1_1 hd_b_niceng242er9.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p><a class="bibr" href="#niceng242er9.s1.1.ref6" rid="niceng242er9.s1.1.ref6">Kandasamy 2019</a> (DIMECat)</p>
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<p>Australia</p>
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<p>n=65 eyes from 62 people</p>
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</td><td headers="hd_h_niceng242er9.tab3_1_1_1_2 hd_b_niceng242er9.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 months</td><td headers="hd_h_niceng242er9.tab3_1_1_1_3 hd_b_niceng242er9.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People aged over 18 years with diabetes and clinically significant macular oedema</td><td headers="hd_h_niceng242er9.tab3_1_1_1_4 hd_b_niceng242er9.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with 1.25 mg bevacizumab injection</td><td headers="hd_h_niceng242er9.tab3_1_1_1_5 hd_b_niceng242er9.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cataract surgery with 4 mg triamcinolone injection</td><td headers="hd_h_niceng242er9.tab3_1_1_1_6 hd_b_niceng242er9.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Best corrected visual acuity</div></li><li class="half_rhythm"><div>Rates of additional intervention (number of additional treatments)</div></li><li class="half_rhythm"><div>Adverse events (raised intraocular pressure)</div></li></ul>
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</td></tr><tr><td headers="hd_h_niceng242er9.tab3_1_1_1_1 hd_b_niceng242er9.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a class="bibr" href="#niceng242er9.s1.1.ref8" rid="niceng242er9.s1.1.ref8">Sasongko 2020</a> (DIMECat)</td><td headers="hd_h_niceng242er9.tab3_1_1_1_2 hd_b_niceng242er9.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">As for <a class="bibr" href="#niceng242er9.s1.1.ref6" rid="niceng242er9.s1.1.ref6">Kandasamy 2019</a></td><td headers="hd_h_niceng242er9.tab3_1_1_1_3 hd_b_niceng242er9.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng242er9.tab3_1_1_1_4 hd_b_niceng242er9.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng242er9.tab3_1_1_1_5 hd_b_niceng242er9.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng242er9.tab3_1_1_1_6 hd_b_niceng242er9.tab3_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Progression</div></li></ul>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng242er9tab4"><div id="niceng242er9.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Anti-VEGF agents vs control in people with non-proliferative diabetic retinopathy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK607258/table/niceng242er9.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng242er9.tab4_lrgtbl__"><table><thead><tr><th id="hd_h_niceng242er9.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcome</th><th id="hd_h_niceng242er9.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th id="hd_h_niceng242er9.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_niceng242er9.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect estimate</th><th id="hd_h_niceng242er9.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_niceng242er9.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Interpretation of effect</th></tr></thead><tbody><tr><td headers="hd_h_niceng242er9.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Best corrected visual acuity measured with logMAR (change from baseline)</td><td headers="hd_h_niceng242er9.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">2</td><td headers="hd_h_niceng242er9.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">137</td><td headers="hd_h_niceng242er9.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">MD −0.07 (−0.14, −0.00)</td><td headers="hd_h_niceng242er9.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">low</td><td headers="hd_h_niceng242er9.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect favouring anti-VEGFs</td></tr><tr><td headers="hd_h_niceng242er9.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Best corrected visual acuity measured with ETDRS (change from baseline)</td><td headers="hd_h_niceng242er9.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">30</td><td headers="hd_h_niceng242er9.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">MD 1.36 (−4.20, 6.92)</td><td headers="hd_h_niceng242er9.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">high</td><td headers="hd_h_niceng242er9.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr><tr><td headers="hd_h_niceng242er9.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Progression to a higher grade of diabetic retinopathy or to diabetic macular oedema</td><td headers="hd_h_niceng242er9.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">3</td><td headers="hd_h_niceng242er9.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">166</td><td headers="hd_h_niceng242er9.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">RR 0.60 (0.29, 1.23)</td><td headers="hd_h_niceng242er9.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">moderate</td><td headers="hd_h_niceng242er9.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr><tr><td headers="hd_h_niceng242er9.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of ocular treatments related adverse events</td><td headers="hd_h_niceng242er9.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">2</td><td headers="hd_h_niceng242er9.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">91</td><td headers="hd_h_niceng242er9.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">RR 0.91 (0.57, 1.45)</td><td headers="hd_h_niceng242er9.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">high</td><td headers="hd_h_niceng242er9.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng242er9tab5"><div id="niceng242er9.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Intravitreal steroids vs control in people with non-proliferative diabetic retinopathy</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK607258/table/niceng242er9.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng242er9.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_niceng242er9.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcome</th><th id="hd_h_niceng242er9.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th id="hd_h_niceng242er9.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_niceng242er9.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect estimate</th><th id="hd_h_niceng242er9.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_niceng242er9.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Interpretation of effect</th></tr></thead><tbody><tr><td headers="hd_h_niceng242er9.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Best corrected visual acuity measured with logMAR (change from baseline)</td><td headers="hd_h_niceng242er9.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">41</td><td headers="hd_h_niceng242er9.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">MD −0.02 (−0.08, 0.04)</td><td headers="hd_h_niceng242er9.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">moderate</td><td headers="hd_h_niceng242er9.tab5_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr><tr><th headers="hd_h_niceng242er9.tab5_1_1_1_1 hd_h_niceng242er9.tab5_1_1_1_2 hd_h_niceng242er9.tab5_1_1_1_3 hd_h_niceng242er9.tab5_1_1_1_4 hd_h_niceng242er9.tab5_1_1_1_5 hd_h_niceng242er9.tab5_1_1_1_6" id="hd_b_niceng242er9.tab5_1_1_2_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">Progression to macular oedema or Severe non-proliferative diabetic retinopathy</th></tr><tr><td headers="hd_h_niceng242er9.tab5_1_1_1_1 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Subgroup: macular oedema</td><td headers="hd_h_niceng242er9.tab5_1_1_1_2 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab5_1_1_1_3 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">41</td><td headers="hd_h_niceng242er9.tab5_1_1_1_4 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">RR 0.12 (0.01, 2.03)</td><td headers="hd_h_niceng242er9.tab5_1_1_1_5 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">moderate</td><td headers="hd_h_niceng242er9.tab5_1_1_1_6 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr><tr><td headers="hd_h_niceng242er9.tab5_1_1_1_1 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Subgroup: severe non-proliferative diabetic retinopathy</td><td headers="hd_h_niceng242er9.tab5_1_1_1_2 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab5_1_1_1_3 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">41</td><td headers="hd_h_niceng242er9.tab5_1_1_1_4 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">RR 0.26 (0.03, 2.15)</td><td headers="hd_h_niceng242er9.tab5_1_1_1_5 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">moderate</td><td headers="hd_h_niceng242er9.tab5_1_1_1_6 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr><tr><td headers="hd_h_niceng242er9.tab5_1_1_1_1 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Rates of additional intervention (number who needed rescue treatments)</td><td headers="hd_h_niceng242er9.tab5_1_1_1_2 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab5_1_1_1_3 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">21</td><td headers="hd_h_niceng242er9.tab5_1_1_1_4 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">RR 1.00 (0.24, 4.20)</td><td headers="hd_h_niceng242er9.tab5_1_1_1_5 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">high</td><td headers="hd_h_niceng242er9.tab5_1_1_1_6 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr><tr><td headers="hd_h_niceng242er9.tab5_1_1_1_1 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Adverse events (raised intraocular pressure: increase >21 mm hg)</td><td headers="hd_h_niceng242er9.tab5_1_1_1_2 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab5_1_1_1_3 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">42</td><td headers="hd_h_niceng242er9.tab5_1_1_1_4 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">RR 7.00 (0.38, 127.69)</td><td headers="hd_h_niceng242er9.tab5_1_1_1_5 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">moderate</td><td headers="hd_h_niceng242er9.tab5_1_1_1_6 hd_b_niceng242er9.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng242er9tab6"><div id="niceng242er9.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Anti-VEGF agents vs control in people with non-proliferative diabetic retinopathy and diabetic macular oedema</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK607258/table/niceng242er9.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng242er9.tab6_lrgtbl__"><table><thead><tr><th id="hd_h_niceng242er9.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcome</th><th id="hd_h_niceng242er9.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th id="hd_h_niceng242er9.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_niceng242er9.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect estimate</th><th id="hd_h_niceng242er9.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_niceng242er9.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Interpretation of effect</th></tr></thead><tbody><tr><td headers="hd_h_niceng242er9.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Best corrected visual acuity measured with Snellen (change from baseline)</td><td headers="hd_h_niceng242er9.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">26</td><td headers="hd_h_niceng242er9.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">MD 0.23 (0.08, 0.38)</td><td headers="hd_h_niceng242er9.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">moderate</td><td headers="hd_h_niceng242er9.tab6_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect favouring anti-VEGFs</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng242er9tab7"><div id="niceng242er9.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Intravitreal steroids pre-surgery vs post-surgery in people with non-proliferative diabetic retinopathy and diabetic macular oedema</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK607258/table/niceng242er9.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng242er9.tab7_lrgtbl__"><table><thead><tr><th id="hd_h_niceng242er9.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcome</th><th id="hd_h_niceng242er9.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th id="hd_h_niceng242er9.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_niceng242er9.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect estimate</th><th id="hd_h_niceng242er9.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_niceng242er9.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Interpretation of effect</th></tr></thead><tbody><tr><td headers="hd_h_niceng242er9.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Best corrected visual acuity measured with logMAR (change from baseline)</td><td headers="hd_h_niceng242er9.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">40</td><td headers="hd_h_niceng242er9.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">MD −0.04 (−0.13, 0.05)</td><td headers="hd_h_niceng242er9.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">low</td><td headers="hd_h_niceng242er9.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng242er9tab8"><div id="niceng242er9.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Intravitreal steroids vs control in people with non-proliferative diabetic retinopathy and diabetic macular oedema</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK607258/table/niceng242er9.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng242er9.tab8_lrgtbl__"><table><thead><tr><th id="hd_h_niceng242er9.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcome</th><th id="hd_h_niceng242er9.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th id="hd_h_niceng242er9.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_niceng242er9.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect estimate</th><th id="hd_h_niceng242er9.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_niceng242er9.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Interpretation of effect</th></tr></thead><tbody><tr><td headers="hd_h_niceng242er9.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Rates of additional intervention (number who needed rescue treatments)</td><td headers="hd_h_niceng242er9.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">151</td><td headers="hd_h_niceng242er9.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">RR 0.82 (0.57, 1.17)</td><td headers="hd_h_niceng242er9.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">high</td><td headers="hd_h_niceng242er9.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng242er9tab9"><div id="niceng242er9.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">Anti-VEGF agents vs intravitreal steroids in people with non-proliferative diabetic retinopathy and diabetic macular oedema</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK607258/table/niceng242er9.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng242er9.tab9_lrgtbl__"><table><thead><tr><th id="hd_h_niceng242er9.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcome</th><th id="hd_h_niceng242er9.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Number of studies</th><th id="hd_h_niceng242er9.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Sample size</th><th id="hd_h_niceng242er9.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect estimate</th><th id="hd_h_niceng242er9.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Quality</th><th id="hd_h_niceng242er9.tab9_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Interpretation of effect</th></tr></thead><tbody><tr><td headers="hd_h_niceng242er9.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Best corrected visual acuity measured with letters (change from baseline)</td><td headers="hd_h_niceng242er9.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">61</td><td headers="hd_h_niceng242er9.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">MD −5.50 (−13.07, 2.07)</td><td headers="hd_h_niceng242er9.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">high</td><td headers="hd_h_niceng242er9.tab9_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr><tr><th headers="hd_h_niceng242er9.tab9_1_1_1_1 hd_h_niceng242er9.tab9_1_1_1_2 hd_h_niceng242er9.tab9_1_1_1_3 hd_h_niceng242er9.tab9_1_1_1_4 hd_h_niceng242er9.tab9_1_1_1_5 hd_h_niceng242er9.tab9_1_1_1_6" id="hd_b_niceng242er9.tab9_1_1_2_1" colspan="6" rowspan="1" style="text-align:left;vertical-align:top;">Progression to a higher grade of diabetic retinopathy</th></tr><tr><td headers="hd_h_niceng242er9.tab9_1_1_1_1 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Subgroup: 1-step progression</td><td headers="hd_h_niceng242er9.tab9_1_1_1_2 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab9_1_1_1_3 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">61</td><td headers="hd_h_niceng242er9.tab9_1_1_1_4 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">RR 1.18 (0.26, 5.38)</td><td headers="hd_h_niceng242er9.tab9_1_1_1_5 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">high</td><td headers="hd_h_niceng242er9.tab9_1_1_1_6 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr><tr><td headers="hd_h_niceng242er9.tab9_1_1_1_1 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Subgroup: 2-step progression</td><td headers="hd_h_niceng242er9.tab9_1_1_1_2 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab9_1_1_1_3 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">61</td><td headers="hd_h_niceng242er9.tab9_1_1_1_4 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">RR 0.39 (0.02, 9.23)</td><td headers="hd_h_niceng242er9.tab9_1_1_1_5 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">high</td><td headers="hd_h_niceng242er9.tab9_1_1_1_6 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr><tr><td headers="hd_h_niceng242er9.tab9_1_1_1_1 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Rates of additional intervention (number who needed retreatments)</td><td headers="hd_h_niceng242er9.tab9_1_1_1_2 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab9_1_1_1_3 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">65</td><td headers="hd_h_niceng242er9.tab9_1_1_1_4 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">RR 2.36 (1.19, 4.67)</td><td headers="hd_h_niceng242er9.tab9_1_1_1_5 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">high</td><td headers="hd_h_niceng242er9.tab9_1_1_1_6 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Effect favouring intravitreal steroids</td></tr><tr><td headers="hd_h_niceng242er9.tab9_1_1_1_1 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Adverse events (number of people with raised intraocular pressure: increase >21 mm hg)</td><td headers="hd_h_niceng242er9.tab9_1_1_1_2 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">1</td><td headers="hd_h_niceng242er9.tab9_1_1_1_3 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">65</td><td headers="hd_h_niceng242er9.tab9_1_1_1_4 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">RR 0.82 (0.20, 3.39)</td><td headers="hd_h_niceng242er9.tab9_1_1_1_5 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">high</td><td headers="hd_h_niceng242er9.tab9_1_1_1_6 hd_b_niceng242er9.tab9_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Could not differentiate</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng242er9tab10"><div id="niceng242er9.tab10" class="table"><h3><span class="label">Table 10</span><span class="title">List prices of treatment alongside cataract surgery</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK607258/table/niceng242er9.tab10/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng242er9.tab10_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng242er9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Resource</th><th id="hd_h_niceng242er9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Unit costs</th><th id="hd_h_niceng242er9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Source</th></tr></thead><tbody><tr><td headers="hd_h_niceng242er9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Aflibercept 4.0mg/0.1ml</td><td headers="hd_h_niceng242er9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£816.00</td><td headers="hd_h_niceng242er9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">BNF (accessed 13/02/23)</td></tr><tr><td headers="hd_h_niceng242er9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ranibizumab 2.3mg/0.23ml</td><td headers="hd_h_niceng242er9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£551.00</td><td headers="hd_h_niceng242er9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">BNF (accessed 13/02/23)</td></tr><tr><td headers="hd_h_niceng242er9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Ranibizumab biosimilar (Ongavia) 2.3mg/0.23ml</td><td headers="hd_h_niceng242er9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£523.45</td><td headers="hd_h_niceng242er9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">BNF (accessed 13/02/23)</td></tr><tr><td headers="hd_h_niceng242er9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bevacizumab<sup>*</sup> 1.25mg</td><td headers="hd_h_niceng242er9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£50.00</td><td headers="hd_h_niceng242er9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a class="bibr" href="#niceng242er9.s1.1.ref13" rid="niceng242er9.s1.1.ref13">Poku et al (2012)</a> cited in NICE TA824</td></tr><tr><td headers="hd_h_niceng242er9.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dexamethasone 700 microgram</td><td headers="hd_h_niceng242er9.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£870.00</td><td headers="hd_h_niceng242er9.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">BNF (accessed 13/02/23)</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>*</dt><dd><div id="niceng242er9.tab10_1"><p class="no_margin">Bevacizumab is only available in a 100mg per 4ml vial at a list price of £242.66, and for intravitreal use must be reconstituted into a 1.25mg dose in an aseptic pharmacy.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng242er9appjtab1"><div id="niceng242er9.appj.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK607258/table/niceng242er9.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng242er9.appj.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason</th></tr></thead><tbody><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Agarwal, Aniruddha, Gupta, Vishali, Ram, Jagat
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et al. (2013) Dexamethasone intravitreal implant during phacoemulsification. Ophthalmology
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120(1): 211–5
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[<a href="https://pubmed.ncbi.nlm.nih.gov/23283186" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23283186</span></a>]
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</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Mixed population. Outcomes not reported by relevant subgroups</p>
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<p>
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<i>Includes people with non-proliferative retinopathy, proliferative retinopathy and with or without macular oedema. Results not reported separately</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Akinci, Arsen, Batman, Cosar, Ozkilic, Ersel
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et al. (2009) Phacoemulsification with intravitreal bevacizumab injection in diabetic patients with macular edema and cataract. Retina (Philadelphia, Pa.)
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29(10): 1432–5
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[<a href="https://pubmed.ncbi.nlm.nih.gov/19898181" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19898181</span></a>]
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</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Akinci, Arsen, Muftuoglu, Orkun, Altinsoy, Ali
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et al. (2011) Phacoemulsification with intravitreal bevacizumab and triamcinolone acetonide injection in diabetic patients with clinically significant macular edema and cataract. Retina (Philadelphia, Pa.)
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31(4): 755–8
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[<a href="https://pubmed.ncbi.nlm.nih.gov/21124251" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21124251</span></a>]
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</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Amana-Rattan, S., Kadhim-Mutasher, M., Farhood, Q.
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et al. (2022) Posterior subtenon triamcinolone acetonide combined with phacoemulsification for patients with diabetic maculopathy. Revista Mexicana de Oftalmologia
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96(3): 108–113
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</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Angkadjaja, Julia, Chu, Joshua, Sierpina, David I
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et al. (2020) Evaluating the effect of intravitreal triamcinolone-moxifloxacin during cataract surgery on central macular edema in patients with preexisting diabetic retinopathy. Journal of cataract and refractive surgery
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46(9): 1253–1259
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[<a href="https://pubmed.ncbi.nlm.nih.gov/32384419" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32384419</span></a>]
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</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Comparator in study does not match that specified in protocol</p>
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<p>
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<i>No comparator group</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Brito, Pedro N, Rosas, Vitor M, Coentrao, Luis M
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et al. (2015) Evaluation of visual acuity, macular status, and subfoveal choroidal thickness changes after cataract surgery in eyes with diabetic retinopathy. Retina (Philadelphia, Pa.)
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35(2): 294–302
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[<a href="https://pubmed.ncbi.nlm.nih.gov/25118827" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25118827</span></a>]
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</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Not a relevant study design</p>
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<p>
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<i>People with NPDR, PDR without MO and DR with MO. Only 1 group was given bevacizumab</i>
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</p>
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</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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Cheema, Rizwan A, Al-Mubarak, Mahdi M, Amin, Yasir M
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et al. (2009) Role of combined cataract surgery and intravitreal bevacizumab injection in preventing progression of diabetic retinopathy: prospective randomized study. Journal of cataract and refractive surgery
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35(1): 18–25
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[<a href="https://pubmed.ncbi.nlm.nih.gov/19101420" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19101420</span></a>]
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</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>- Mixed population. Outcomes not reported by relevant subgroups</p>
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<p>
|
|
<i>Includes people with and without diabetic macular oedema. Results not reported separately</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Chen, Chih-Hsin; Liu, Ya-Chi; Wu, Pei-Chang (2009) The combination of intravitreal bevacizumab and phacoemulsification surgery in patients with cataract and coexisting diabetic macular edema. Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics
|
|
25(1): 83–9
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/19232012" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19232012</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- RCT with relevant comparison included in this review</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Chew, E Y, Benson, W E, Remaley, N A
|
|
et al. (1999) Results after lens extraction in patients with diabetic retinopathy: early treatment diabetic retinopathy study report number 25. Archives of ophthalmology (Chicago, Ill. : 1960)
|
|
117(12): 1600–6
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/10604663" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10604663</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Corbelli, Eleonora, Fasce, Francesco, Iuliano, Lorenzo
|
|
et al. (2020) Cataract surgery with combined versus defeRRed intravitreal dexamethasone implant for diabetic macular edema: long-term outcomes from a real-world setting. Acta diabetologica
|
|
57(10): 1193–1201
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/32367246" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32367246</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Does not include relevant outcomes</p>
|
|
<p>
|
|
<i>doesn’t adjust for confounding factors (which is specified in the protocol)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
El-Ghrably, Ibraheem, Steel, David H W, Habib, Maged
|
|
et al. (2017) Diabetic macular edema outcomes in eyes treated with fluocinolone acetonide 0.2 microg/d intravitreal implant: real-world UK experience. European journal of ophthalmology
|
|
27(3): 357–362
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/28165610" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28165610</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fallico, Matteo, Avitabile, Teresio, Castellino, Niccolo
|
|
et al. (2021) Intravitreal dexamethasone implant one month before versus concomitant with cataract surgery in patients with diabetic macular oedema: the dexcat study. Acta ophthalmologica
|
|
99(1): e74–e80
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/32588978" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32588978</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Does not include relevant outcomes</p>
|
|
<p>
|
|
<i>doesn’t adjust for confounding factors (which is specified in the protocol)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fallico, Matteo, Lotery, Andrew, Maugeri, Andrea
|
|
et al. (2021) Intravitreal dexamethasone implant versus anti-vascular endothelial growth factor therapy combined with cataract surgery in patients with diabetic macular oedema: a systematic review with meta-analysis. Eye (London, England) [<a href="/pmc/articles/PMC9674685/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9674685</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34795415" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34795415</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Systematic review used as source of primary studies</p>
|
|
<p>
|
|
<i><a class="bibr" href="#niceng242er9.appj.ref51" rid="niceng242er9.appj.ref51">Yumusak 2016</a> added to database</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fang, T, Liu, F, Shu, H-E
|
|
et al. (2012) Clinical study of inhibition of triamcinolone acetonide on posterior capsule opacification in diabetic cataract surgery. International eye science
|
|
12(9): 1659–1661
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Feng, Yifan, Zhu, Senmiao, Skiadaresi, Eirini
|
|
et al. (2019) PHACOEMULSIFICATION CATARACT SURGERY WITH PROPHYLACTIC INTRAVITREAL BEVACIZUMAB FOR PATIENTS WITH COEXISTING DIABETIC RETINOPATHY: A Meta-Analysis. Retina (Philadelphia, Pa.)
|
|
39(9): 1720–1731
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/29975344" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29975344</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fraser-Bell, S., Kang, H.K., Mitchell, P.
|
|
et al. (2021) Dexamethasone intravitreal implant in treatment-naive diabetic macular oedema: findings from the prospective, multicentre, AUSSIEDEX study. The British journal of ophthalmology [<a href="/pmc/articles/PMC9763166/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9763166</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34433549" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34433549</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fukushima, H, Kato, S, Kaiya, T
|
|
et al. (2001) Effect of subconjunctival steroid injection on intraocular inflammation and blood glucose level after cataract surgery in diabetic patients. Journal of cataract and refractive surgery
|
|
27(9): 1386–91
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/11566520" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11566520</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Does not include relevant outcomes</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Fukushima, H, Kato, S, Kaiya, T
|
|
et al. (1999) Effect of subconjunctival corticosteroid immediately after cataract surgery in diabetic patients. Japanese journal of clinical ophthalmology
|
|
53(13): 2001–2004
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Furino, Claudio, Boscia, Francesco, Niro, Alfredo
|
|
et al. (2021) DIABETIC MACULAR EDEMA AND CATARACT SURGERY: Phacoemulsification Combined With Dexamethasone Intravitreal Implant Compared With Standard Phacoemulsification. Retina (Philadelphia, Pa.)
|
|
41(5): 1102–1109
|
|
[<a href="/pmc/articles/PMC8078110/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8078110</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32897932" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32897932</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Does not include relevant outcomes</p>
|
|
<p>
|
|
<i>doesn’t adjust for confounding factors (which is specified in the protocol)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gallego-Pinazo, Roberto, Dolz-Marco, Rosa, BeRRocal, Maria
|
|
et al. (2014) Outcomes of cataract surgery in diabetic patients: results of the Pan American Collaborative Retina Study Group. Arquivos brasileiros de oftalmologia
|
|
77(6): 355–9
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/25627180" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25627180</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Does not include a relevant population</p>
|
|
<p>
|
|
<i>Includes people with non-proliferative and proliferative DR. Results not reported separately</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hu, M (2017) Clinical study on the treatment of PDR with cataract by vitreous cavity injection and intraocular lens implantation. International eye science
|
|
17(2): 281–283
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hykin, PG, Dowler, JGF, Sehmi, K
|
|
et al. (1997) Indirect laser panretinal photocoagulation during phakoemulsification in eyes with proliferative diabetic retinopathy. IOVS
|
|
38: arvoabstract3546
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Conference abstract</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Javed, M.A., Latif, S., Javaid, R.M.M.
|
|
et al. (2022) Prophylaxis of Macular Edema with Preoperative Intravitreal Bevacizumab in Patients with Diabetic Retinopathy Undergoing Phacoemulsification. Pakistan Journal of Medical and Health Sciences
|
|
16(3): 737–739
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Mixed population. Outcomes not reported by relevant subgroups</p>
|
|
<p>
|
|
<i>Includes people with and without diabetic macular oedema. Results not reported separately</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Khodabandeh, A., Fadaifard, S., Abdollahi, A.
|
|
et al. (2018) Role of combined phacoemulsification and intravitreal injection of bevacizumab in prevention of postoperative macular edema in non-proliferative diabetic retinopathy. Journal of CuRRent Ophthalmology
|
|
30(3): 245–249
|
|
[<a href="/pmc/articles/PMC6127363/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6127363</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30197955" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30197955</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Mixed population. Outcomes not reported by relevant subgroups</p>
|
|
<p>
|
|
<i>Includes people with no diabetic retinopathy and non-proliferative retinopathy. Results not reported separately (most had no retinopathy)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kim, Su-Young, Yang, Jiwook, Lee, Young-Chun
|
|
et al. (2008) Effect of a single intraoperative sub-Tenon injection of triamcinolone acetonide on the progression of diabetic retinopathy and visual outcomes after cataract surgery. Journal of cataract and refractive surgery
|
|
34(5): 823–6
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/18471640" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18471640</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- RCT with relevant comparison included in this review</p>
|
|
<p>
|
|
<i>Triamcinolone vs control for people with non-proliferative diabetic retinopathy</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kwon, Soon Il, Hwang, Duck Jin, Seo, Ji Young
|
|
et al. (2011) Evaluation of changes of macular thickness in diabetic retinopathy after cataract surgery. Korean journal of ophthalmology : KJO
|
|
25(4): 238–42
|
|
[<a href="/pmc/articles/PMC3149133/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3149133</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21860569" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21860569</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Li, J-Y, Shao, J, Wang, Y
|
|
et al. (2013) Clinical observation of macular grid photocoagulation before cataract surgery for diabetes patients with diffuse macular edema. International eye science
|
|
13(9): 1887–1889
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lim, Lyndell L, MoRRison, Julie L, Constantinou, Marios
|
|
et al. (2016) Diabetic Macular Edema at the time of Cataract Surgery trial: a prospective, randomized clinical trial of intravitreous bevacizumab versus triamcinolone in patients with diabetic macular oedema at the time of cataract surgery - preliminary 6 month results. Clinical & experimental ophthalmology
|
|
44(4): 233–42
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/26871700" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26871700</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Relevant study but doesn’t report latest timepoint</p>
|
|
<p>
|
|
<i>DIMECat study - pilot results. 6 month results reported in follow-up papers (<a class="bibr" href="#niceng242er9.s1.1.ref6" rid="niceng242er9.s1.1.ref6">Kandasamy 2019</a>, <a class="bibr" href="#niceng242er9.s1.1.ref8" rid="niceng242er9.s1.1.ref8">Sasongko 2020</a>)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Limon, Utku and Sezgin
|
|
Akcay, Betul
|
|
Ilkay (2022) Efficacy of Intravitreal Dexamethasone After Combined Phacoemulsification and Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachments. Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics
|
|
38(2): 176–182
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/34665023" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34665023</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study does not contain a relevant intervention</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lin, W-H, Lu, M, Tang, H-Y
|
|
et al. (2015) Clinical application of Ranibizumab in the therapy of diabetic cataract. International eye science
|
|
15(5): 880–882
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Minnella, Angelo Maria, Maceroni, Martina, Picardi, Stefano Maria
|
|
et al. (2020) Combined Intravitreal Dexamethasone Implant and Cataract Surgery in Patients with Diabetic Retinopathy: Effect on Retinal Morphology and Function. Advances in therapy
|
|
37(11): 4675–4684
|
|
[<a href="/pmc/articles/PMC7547947/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7547947</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32970316" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32970316</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Not a relevant study design</p>
|
|
<p>
|
|
<i>Observational study that does not include a comparator group</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Moshfeghi, Andrew A, Shapiro, Howard, Lemmon, Linda A
|
|
et al. (2018) Impact of Cataract Surgery during Treatment with Ranibizumab in Patients with Diabetic Macular Edema. Ophthalmology. Retina
|
|
2(2): 86–90
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/31047350" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31047350</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Moshfeghi, Andrew A, Thompson, Desmond, Berliner, Alyson J
|
|
et al. (2020) Outcomes in Patients with Diabetic Macular Edema Requiring Cataract Surgery in VISTA and VIVID Studies. Ophthalmology. Retina
|
|
4(5): 481–485
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/31924543" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31924543</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Ozgur, O.R., Ozkurt, Y., Kulekci, Z.
|
|
et al. (2016) The combination of phacoemulsification surgery and intravitreal triamcinolone injection in patients with cataract and diabetic macular edema. Saudi Journal of Ophthalmology
|
|
30(1): 33–38
|
|
[<a href="/pmc/articles/PMC4759512/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4759512</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26949356" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26949356</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Does not include relevant outcomes</p>
|
|
<p>
|
|
<i>doesn’t adjust for confounding factors (which is specified in the protocol)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Rauen, Paulo I, Ribeiro, Jefferson A S, Almeida, Felipe P P
|
|
et al. (2012) Intravitreal injection of ranibizumab during cataract surgery in patients with diabetic macular edema. Retina (Philadelphia, Pa.)
|
|
32(9): 1799–803
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/22495327" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22495327</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Salehi, Ali, Beni, Afsaneh Naderi, Razmjoo, Hassan
|
|
et al. (2012) Phacoemulcification with intravitreal bevacizumab injection in patients with cataract and coexisting diabetic retinopathy: prospective randomized study. Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics
|
|
28(3): 212–8
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/22132722" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22132722</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Mixed population. Outcomes not reported by relevant subgroups</p>
|
|
<p>
|
|
<i>Includes people with non-proliferative and proliferative retinopathy, with and without macular oedema. Separates results by type of retinopathy but not by whether they have macular oedema</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Shi, X., Dong, N., Liang, Y.
|
|
et al. (2022) 23G Minimally Invasive Vitrectomy Combined with Glaucoma Drainage Valve Implantation and Phacoemulsification Cataract Extraction for Neovascular Glaucoma Secondary to Proliferative Diabetic Retinopathy with Vitreous HemoRRhage. Computational and Mathematical Methods in Medicine
|
|
2022: 7393661
|
|
[<a href="/pmc/articles/PMC9371887/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9371887</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35966245" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35966245</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
StaRR, Matthew R, Mahr, Michael A, Smith, Wendy M
|
|
et al. (2021) Outcomes of Patients With Active Diabetic Macular Edema at the Time of Cataract Surgery Managed With Intravitreal Anti-Vascular Endothelial Growth Factor Injections. American journal of ophthalmology
|
|
229: 194–199
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/33852907" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33852907</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Comparator in study does not match that specified in protocol</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Suto, Chikako; Hori, Sadao; Kato, Satoshi (2008) Management of type 2 diabetics requiring panretinal photocoagulation and cataract surgery. Journal of cataract and refractive surgery
|
|
34(6): 1001–6
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/18499009" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18499009</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Mixed population. Outcomes not reported by relevant subgroups</p>
|
|
<p>
|
|
<i>Includes people with severe non-proliferative retinopathy and early proliferative retinopathy. Results not separated by type of retinopathy</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Suto, Chikako; Kitano, Shigehiko; Hori, Sadao (2011) Optimal timing of cataract surgery and panretinal photocoagulation for diabetic retinopathy. Diabetes care
|
|
34(7): e123
|
|
[<a href="/pmc/articles/PMC3120170/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3120170</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21709289" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21709289</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Not a peer-reviewed publication</p>
|
|
<p>
|
|
<i>Letter</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Sze, Amy M, Luk, Fiona O, Yip, TeRRi P
|
|
et al. (2015) Use of intravitreal dexamethasone implant in patients with cataract and macular edema undergoing phacoemulsification. European journal of ophthalmology
|
|
25(2): 168–72
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/25363857" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25363857</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Not a relevant study design</p>
|
|
<p>
|
|
<i>Case series</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Takata, Clecio, Messias, Andre, Folgosa, Marco S
|
|
et al. (2010) Intravitreal injection versus subtenon infusion of triamcinolone acetonide during cataract surgery in patients with refractory diabetic macular edema. Retina (Philadelphia, Pa.)
|
|
30(4): 562–9
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/20182403" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20182403</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Mixed population. Outcomes not reported by relevant subgroups</p>
|
|
<p>
|
|
<i>Includes people with non-proliferative and proliferative DR. Results not reported separately</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Tang, B., Wang, X., Luo, Y.
|
|
et al. (2022) Efficacy and Safety of Intravitreal Injection of Triamcinolone Acetonide and Conbercept for Intraocular Lens after Cataract Surgery. Evidence-based Complementary and Alternative Medicine
|
|
2022: 5606343
|
|
[<a href="/pmc/articles/PMC9159890/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9159890</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35664937" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35664937</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain a relevant intervention</p>
|
|
<p>
|
|
<i>Conbercept anti-VEGF. Not cuRRently licensed in the UK</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Tang, H-Y, Lu, M, Hong, D-M
|
|
et al. (2015) Effect and safety of intrachamberal triamcinolone acetonide injection during cataract surgery in diabetic patients. International eye science
|
|
15(3): 474–477
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Tatsumi, Tomoaki, Oshitari, Toshiyuki, Ando, Takaaki
|
|
et al. (2019) Comparison of the Efficacy of Sub-Tenon versus Intravitreal Triamcinolone Acetonide Injection during Cataract Surgery for Diabetic Macular Edema. Ophthalmologica. Journal international d’ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde
|
|
241(1): 17–23 [<a href="https://pubmed.ncbi.nlm.nih.gov/30041252" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30041252</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Not a relevant study design</p>
|
|
<p>
|
|
<i>doesn’t adjust for confounding factors (which is specified in the protocol)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Wahab, Shahid and Ahmed, Jamshed (2010) Management of cataract with macular oedema due to diabetes mellitus type-II and hypertension with grid laser prior to surgery and intra-vitreal bevacizumab (Avastin) peroperatively. JPMA. The Journal of the Pakistan Medical Association
|
|
60(10): 836–9
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/21381615" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21381615</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Not a relevant study design</p>
|
|
<p>
|
|
<i>Observational study that does not include a comparator group</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Wang, J., Liu, Y., Hu, Y.
|
|
et al. (2021) Clinical Observation of Phacoemulsification Combined with Intravitreal Injection of Conbercept in Cataract Patients with Diabetic Macular Edema. Journal of Ophthalmology
|
|
2021: 8849730
|
|
[<a href="/pmc/articles/PMC7884183/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7884183</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33628483" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33628483</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain a relevant intervention</p>
|
|
<p>
|
|
<i>Not cuRRently licensed in the UK</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Wielders, Laura H P, Schouten, Jan S A G, Winkens, Bjorn
|
|
et al. (2018) Randomized controlled European multicenter trial on the prevention of cystoid macular edema after cataract surgery in diabetics: ESCRS PREMED Study Report 2. Journal of cataract and refractive surgery
|
|
44(7): 836–847
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/30055692" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30055692</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Does not include a relevant population</p>
|
|
<p>
|
|
<i>People with cystoid macular oedema</i>
|
|
</p>
|
|
<p>- Mixed population. Outcomes not reported by relevant subgroups</p>
|
|
<p>
|
|
<i>Includes people with no diabetic retinopathy, non-proliferative retinopathy and proliferative retinopathy. Results not reported separately</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Yang, B and Song, Y (2015) Therapeutic effects of phacoemulsification combined with intravitreal injection of triamcinolone in treating cataract with diabetic macular edema. International eye science
|
|
15(9): 1532–1535
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Yen, Chu-Yu, Yen, Ju-Chuan, Chen, Chun-Chen
|
|
et al. (2022) Therapeutic effect of cataract surgery with simultaneous intravitreal injection of aflibercept on diabetic macular edema: An observational study. Medicine
|
|
101(33): e30115
|
|
[<a href="/pmc/articles/PMC9387960/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9387960</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35984152" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35984152</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Mixed population. Outcomes not reported by relevant subgroups</p>
|
|
<p>
|
|
<i>Includes people with non-proliferative and proliferative DR. Results not reported separately</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a id="niceng242er9.appj.ref51"></a>Yumusak, E. & Ornek
|
|
K (2016) Comparison of Perioperative Ranibizumab Injections for Diabetic Macular Edema in Patients Undergoing Cataract Surgery. Journal of Opthalmology [<a href="/pmc/articles/PMC4963569/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4963569</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27493795" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27493795</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Does not include relevant outcomes</p>
|
|
<p>
|
|
<i>doesn’t adjust for confounding factors (which is specified in the protocol)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Zhang, W-L; Zhang, W; Shao, Y (2019) Application of Triamcinolone acetonide in cataract surgery with NPDR. International eye science
|
|
19(9): 1536–1541
|
|
</td><td headers="hd_h_niceng242er9.appj.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng242er9appjtab2"><div id="niceng242er9.appj.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK607258/table/niceng242er9.appj.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng242er9.appj.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng242er9.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Title</th><th id="hd_h_niceng242er9.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng242er9.appj.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Simons, R.W.P., Wielders, L.H.P., Nuijts, R.M.M.A.
|
|
et al. (2021) Economic evaluation of prevention of cystoid macular edema after cataract surgery in diabetic patients: ESCRS PREMED study report 6. Journal of cataract and refractive surgery [<a href="https://pubmed.ncbi.nlm.nih.gov/34417781" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34417781</span></a>]
|
|
</td><td headers="hd_h_niceng242er9.appj.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Exclude - not relevant population, non - retinopathy population</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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