Efficacy of Intravitreal Dexamethasone Implant in Vitrectomized vs. Non-Vitrectomized Eyes: A Systematic Review and Meta-Analysis

We conducted this present meta-analysis to examine the difference in efficacy and safety of intravitreal dexamethasone implant (DEXI) in vitrectomized and non-vitrectomized eyes. All types of comparative studies published on PubMed, CENTRAL, Scopus, and Embase databases till March 10, 2025 were included. We conducted a random-effects meta-analysis for change in central macular thickness (CMT), best corrected visual acuity (BCVA) (as logMar), and rise in intraocular pressure (IOP). Thirteen studies were included comparing 365 vitrectomized eyes with 778 non-vitrectomized eyes. Studies included mixed etiologies of macular edema. Meta-analysis showed that change in CMT was not significantly different between the two groups at 1 month (MD: −11.34 95% CI: −47.51, 24.82 I² = 2%), 3 months (MD: −0.43 95% CI: −33.36, 32.5 I² = 44%), 6 months (MD: −0.69 95% CI: −33.57, 34.95 I² = 18%) or 12 months ((MD: 37.46 95% CI: −4.86, 79.77 I² = 86%). The pooled analysis found no statistically significant difference between the two groups for change in BCVA at 1 month (MD: 0.04 95% CI: −0.01, 0.09 I² = 32%), 3 months (MD: 0.04 95% CI: −0.02, 0.09 I² = 0%) and 6 months (MD: 0.06 95% CI: 0.00, 0.11 I² = 0%). However, change in BCVA was significantly higher in the vitrectomized group at 12 months (MD: 0.17 95% CI: 0.13, 0.22 I² = 54%). The meta-analysis found no statistically significant difference in the risk of a rise in IOP between the two groups (OR: 1.26 95% CI: 0.81, 1.95 I² = 0%). Subgroup analysis based on etiology did not change the results. DEXI may be equally efficacious and safe in vitrectomized and non-vitrectomized eyes.