Acupuncture and related therapies for diabetic retinopathy: A systematic review and network meta-analysis

Diabetic retinopathy (DR) is a significant long-term consequence of diabetes mellitus and is the primary cause of blindness in people of working age. Although acupuncture (AC) and medication are effective, the optimal treatment regimen for DR remains to be further defined. Consequently, we conducted a network meta-analysis to compare the efficacy of AC and the related treatments with that of medicines for DR.

We searched 8 academic electronic databases for randomized controlled trials published before December 1, 2023. The main outcome was the overall effective rate, and the secondary outcomes were the best corrected visual acuity and the central fovea of macula thickness. Two independent researchers identified eligible studies and collected data using pre-made forms. We conducted a network meta-analysis within a Bayesian framework to compare different interventions. The assessment of risk of bias and quality of literature was conducted using the risk of bias assessment tool recommended by the Cochrane Risk of Bias Tool 2 and the Jadad scale. Intervention ranking probabilities for all treatments were performed using the surface under the cumulative ranking curve.

Twenty-eight studies published between 2012 and 2023 were included, involving 2801 patients. Interventions included AC, traditional Chinese medicine (TCM), electroacupuncture (EA), acupoint injections, and calcium dobesilate. In terms of the overall effective rate, EA + AC + TCM was the best treatment (P < .05) and for the best corrected visual acuity, AI + TCM was the best treatment (P < .05). In terms of the central fovea of macula thickness, AC + TCM was the best treatment (P < .05). An integration of AC and the related treatments is more effective than a single therapy.

EA combined with AC combined with TCM may be the most effective treatment for DR. AC and the related treatments have significant efficacy in treating DR, improving vision, and reducing macular edema with relatively few adverse effects. The use of integrative therapies combining AC and its related therapies can be promoted.