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

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

Efficacy of Oxymetazoline 0.1% in Acquired Blepharoptosis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Razan O Bawazir,1,2 Jumanah T Qedair,1,2 Ziad M Bukhari,3 Orjwan S Badghaish,1,2 Rahaf A Hubayni,1,2 Ali S Alsudais,1,2 Mohammed F Qutub2,3 1College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 2King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; 3Ophthalmology Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi ArabiaCorrespondence: Razan O Bawazir, King Saud bin Abdulaziz University for Health Sciences, Jeddah, 22384, Saudi Arabia, Email [email protected]: Abnormal eyelid drooping is a defining feature of blepharoptosis, a disorder that can affect the superior vision field. The standard of care is surgical intervention but may be associated with complications. There is emerging evidence that the direct-acting α-adrenergic agonist ophthalmic solution, oxymetazoline, is effective for blepharoptosis. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of oxymetazoline in the management of blepharoptosis.Patients and Methods: A total of five databases were searched. The inclusion was limited only to randomized controlled trials (RCTs) that evaluated the efficacy of oxymetazoline versus placebo. The efficacy endpoint was the mean change in the marginal reflex distance 1 (MRD 1) from baseline. The safety endpoints were mortality and adverse events (AEs). The weighted mean difference (WMD) was implemented for continuous outcomes. For risk of bias assessment, the Revised Cochrane risk of bias tool for randomized trials was used.Results: 4 RCTs (n = 448) met the eligibility criteria. The meta-analysis yielded a statistically significant higher difference in the WMD in the oxymetazoline group [0.65 mm (95% CI: 0.44 mm to 0.86 mm)] compared to the placebo group [0.26 mm (95% CI: 0.30 mm to 0.48 mm) [p=0.012]. There were no statistically significant differences between the oxymetazoline group [1.2% (95% CI: 0.4– 3.6%)] and the placebo group [1.6% (95% CI: 0.5– 5.3%), p = 0.73] in terms of serious adverse events.Conclusion: Oxymetazoline is an effective and safe medication in the management of acquired blepharoptosis.Keywords: oculoplastic, ptosis, oxymetazoline 0.1%, alpha-adrenergic, eyelid droopin