Port Delivery System Vs Monthly Ranibizumab in VEGF-Driven Macular Disease: A Systematic Review and Meta-Analysis.
Edhem Dogru, Matheus Pedrotti Chavez, Otávio Toth et al.
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In 30 seconds
This systematic review and meta-analysis pooled three randomized controlled trials comparing ranibizumab Port Delivery System (PDS) with monthly intravitreal ranibizumab in adults with neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME). Across 1,149 eyes, visual acuity and central retinal thickness outcomes did not differ significantly between treatments. Ocular adverse events were more frequent with PDS (RR 1.80; 95% CI 1.49-2.17; p < .00001), while systemic adverse events were comparable. Evidence for DME came from a single trial and was considered exploratory.
Key findings
- For nAMD, BCVA did not differ significantly between PDS and monthly ranibizumab (MD - 0.69 letters; 95% CI - 2.52 to 1.14; p = .46).
- For DME, BCVA did not differ significantly (MD 0.20; 95% CI - 1.20 to 1.60; p = .78), with evidence limited to one trial.
- Ocular adverse events were more frequent with PDS (RR 1.80; 95% CI 1.49-2.17; p < .00001; I 2 =74%).
- Systemic adverse events were comparable between groups (RR 1.00; 95% CI 0.89-1.13; p = .98).
Why it matters
The findings suggest that PDS can achieve visual and anatomical outcomes comparable to monthly ranibizumab in nAMD, but this potential treatment-delivery alternative carries more ocular complications. The balance between comparable outcomes and device- or procedure-related harms is relevant when considering treatment options. The evidence for DME is less certain and should be interpreted cautiously.
What to keep in mind
Only three trials were included, and DME evidence came from a single trial. The meta-analysis also found substantial heterogeneity for ocular adverse events (I 2 =74%).