Design: Systematic review and meta-analysis of randomised and observational studies
Population: Patients with nAMD, diabetic macular oedema, retinal vein occlusion or polypoidal choroidal vasculopathy in 25 studies
Primary outcome: Visual acuity, retinal thickness and adverse events
Effect: No significant differences in any outcome over 12 to 63.6 weeks; moderate to high certainty

A systematic review and meta-analysis in Retina (1 October 2026) pooled 25 studies, randomised and observational, comparing biosimilar with reference anti-VEGF injections for neovascular macular degeneration, diabetic macular oedema, retinal vein occlusion and polypoidal choroidal vasculopathy. Follow-up ranged from 12 to about 64 weeks.

There was no difference in final visual acuity, change in acuity, final or change in retinal thickness, or adverse events. Subgroups by study design, by disease and by drug (ranibizumab and aflibercept) agreed. The authors graded certainty as moderate to high.

In India, cost is a common reason patients stop anti-VEGF treatment early, and undertreatment costs vision. Biosimilar ranibizumab has been available here for several years. This analysis supports that use, and supports offering a biosimilar when cost would otherwise limit the number of injections a patient can have.

Follow-up is mostly a year or less, and rare adverse events such as intraocular inflammation need longer surveillance.

Offer a biosimilar anti-VEGF when cost would otherwise limit how many injections a patient receives.
Expect similar vision and anatomical outcomes to the reference product over the first year.
Report any intraocular inflammation after a biosimilar injection to pharmacovigilance.
Keep to the same treatment and monitoring schedule whichever product is used.
Avoid switching back and forth between products without a reason, so outcomes can be tracked.

Why it matters

In a cost-limited setting, a cheaper equivalent injection means more patients complete the course that saves their sight.

The statistics, in plain English

No difference across 25 studies, with subgroups agreeing, is good evidence of equivalence over the follow-up studied. It cannot exclude rare adverse events that need thousands of patient-years to detect.