Search Results

Abstract

This study aimed to evaluate the efficacy and safety of topical losartan for treating corneal injuries and stromal fibrosis based on preclinical and clinical evidence. A systematic search was conducted in October 2024 following PRISMA guidelines across Embase, PubMed, Web of Science, and the Cochrane Library. Studies assessing topical losartan use in animal models or human patients with corneal injury were included. No randomized clinical trials were identified. Of 750 articles screened, 12 met the inclusion criteria – seven preclinical studies and five case reports. Preclinical evidence indicated that topical losartan at 0.2-0.8 mg/dL reduced stromal opacity and myofibroblast differentiation. Higher concentrations (8-80 mg/dL) offered no additional benefit and were associated with ocular surface irritation. The five case reports included 11 patients (12 eyes); eight eyes showed visual improvement, and no adverse effects were observed at a dose of 0.8 mg/dL. Topical losartan demonstrates potential as an antifibrotic agent for corneal injuries. However, variability in outcomes and dose-related toxicity at higher concentrations highlight the need for controlled clinical trials to confirm efficacy, establish optimal dosing, and ensure safety.

Keywords: Cornea; Epithelial cells; Myofibroblasts; Corneal opacity; Losartan

Abstract

This systematic review and meta-analysis aimed to compare the effectiveness and safety profiles of anti-vascular endothelial growth factor therapy with dexamethasone vs anti-vascular endothelial growth factor alone in patients with persistent diabetic macular edema. It was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Our data were prospectively registered on the International Prospective Register of Systematic Reviews (CRD42023482385). We searched the PubMed, Embase, Cochrane, and Web of Science databases for studies that compared treatment with anti-vascular endothelial growth factor and dexamethasone to anti-vascular endothelial growth factor alone in patients with persistent diabetic macular edema. The primary outcomes were changes in best corrected visual acuity, changes in central macular thickness, and the incidence of serious adverse events. Four studies were included, totaling 315 eyes. Of these 154 (48.88%) received anti-vascular endothelial growth factor alone, while 161 (51.12%) underwent combined therapy. Overall, combined therapy was associated with better central macular thickness (mean difference −68.21; p<0.001), although this did not translate into a significant difference in best-corrected visual acuity at 1 month follow-up (mean difference 1.29; p=0.55). There were significantly more intraocular pressure-related events (odds ratio 10.84; p=0.02) and cataract-related events (odds ratio 41.24; p<0.001) in the combined group than the anti-vascular endothelial growth factor alone group. Our results suggest that combined therapy improves macular morphology in persistent diabetic macular edema without increasing the risk of serious adverse events. However, its effects on final visual acuity outcomes were no better than those resulting from anti-vascular endothelial growth factor therapy alone.

Keywords: Diabetic macular edema; Macular edema; Central macular thickness Dexamethasone; Ozurdex; Anti-VEGF; Bevacizumab; Ranibizumab