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Intravitreal Diclofenac and Other NSAIDs for the Treatment of Macular Edema: A Systematic Review and Exploratory Meta-Analysis
Journal article   Peer reviewed

Intravitreal Diclofenac and Other NSAIDs for the Treatment of Macular Edema: A Systematic Review and Exploratory Meta-Analysis

Taulant Rama, Syed H.A. Shah and Mukesh Kumar
Ophthalmology Science, Forthcoming
25 Sep 2026
DOI: https://doi.org/10.1016/j.xops.2026.101422
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https://doi.org/10.1016/j.xops.2026.101422View
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Abstract

diclofenac intravitreal injections macular edema nonsteroidal anti-inflammatory drugs NSAIDs
To explore the safety and efficacy of intravitreal NSAIDs in treating macular edema. Macular edema is an ocular condition characterized by fluid accumulation in the retina. Traditionally, laser photocoagulation or intravitreal injections of corticosteroids or anti-VEGF agents are used to treat macular edema, but they are associated with multiple adverse events. Topical NSAIDs are widely used to treat postoperative inflammation and macular edema. Their availability, mechanism, and risk profile make them a potential alternative for intravitreal administration. A systematic search was conducted in PubMed, Embase, Cochrane Library, and SpringerLink databases. Eligible randomized and non-randomized interventional studies were included if they involved intravitreal NSAID administration. Risk of bias was assessed using the RoB2 and the ROBINS-I tools, while the GRADE approach was utilized to assess certainty of evidence. Data were extracted and evaluated using either narrative synthesis or meta-analysis, depending on data availability. Studies missing data for average BCVA and central macular thickness (CMT) were excluded from outcome-specific meta-analysis. Eight studies (six randomized, two nonrandomized) involving 313 subjects and 340 eyes were included. Most included evidence evaluated intravitreal diclofenac, with limited data available for other NSAIDs. All eight studies reported no major adverse events associated with intravitreal NSAIDs. Two studies indicated IOP reduction following administration, while others reported no significant changes. Within-arm meta-analysis of 110 eyes showed nonsignificant improvement in BCVA (-0.19 logMAR; 95%CI, -0.40 to 0.02; p=0.07), while within-arms meta-analysis of 130 eyes revealed significant reductions in CMT (-100.15μm; 95%CI, -193.82 to -6.68; p=0.04) with a large prediction interval (-340.71μm to 140.41μm). Risk of bias assessments identified several studies with some concerns or high risk of bias and evidence certainty was “Very Low” for all outcomes, necessitating tempered interpretation of results. No major adverse events were reported following intravitreal NSAID administration for macular edema. Within-arm pooled analyses demonstrated a nonsignificant improvement in BCVA and significant reductions in CMT following intravitreal diclofenac; however, these findings cannot establish treatment efficacy, and the prediction interval indicated potential improvement or worsening. Although current evidence remains limited, intravitreal NSAIDs warrant further investigation as a potential treatment for macular edema.

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