With loop diuretic therapy appears to be associated with increased survival, and that the degree of benefit increases with increasing diuretic dose. Because of the importance of this question, these results deserve to be replicated. Historically, treatment options for patients with VI due to DME were limited to non-pharmacological interventions, but management options for patients have expanded in recent years. Given the substantial burden of VI due to DME and the evolving options and clinical evidence for treatment, it is important to regularly compare the relative efficacy of available therapies. This study compares the relative efficacy of available first-line therapies that have available data. Before the availability of anti-vascular endothelial growth factor therapy, laser photocoagulation therapy was the standard of care, providing vision stabilization in patients with DME, but with limited efficacy in providing clinically significant improvements in vision. Anti-VEGF therapy is the current standard of care. Ranibizumab is a monoclonal anti-VEGFA antibody fragment administered as intravitreal injections and was the first drug therapy to receive approval for the treatment of VI due to DME. A second anti-VEGF agent, aflibercept, was submitted for European Union marketing authorization on 7 November 2013. The efficacy and safety of the pegylated anti-VEGF aptamer pegaptanib in the treatment of VI due to DME was investigated in phase II and III studies, but the United Kingdom licence application was withdrawn in 2011 and it is understood that an application for a licence will no longer be pursued. Bevacizumab, a full-length anti-VEGF-A antibody developed for the treatment of cancer, has not been developed or licensed for IVT use and is therefore excluded from this analysis. This is consistent with guidance provided by the United Kingdom National Institute for Health and Care Excellence, which states that they “could not consider a comparison of ranibizumab with bevacizumab” and that “evidence, in particular about the balance of harms and benefits associated with bevacizumab, was not readily available for people with diabetic macular oedema”. IVT triamcinolone, a synthetic glucocorticoid, is not licensed for the treatment of DME. IVT TA is not considered a comparator of routine use in the appraisal of anti-VEGF therapy by NICE and is therefore not considered relevant to this analysis. Fluocinolone acetonide IVT implant is approved in Europe only as a second-line therapy and therefore is not considered relevant to this analysis. Several recent reviews have provided synopses of these therapies for DME and the relevant randomized controlled trials . In addition, several recent systematic reviews have compared RCT results for various treatment comparisons, concluding that anti-VEGF therapies BAY 43-9006 consistently demonstrated efficacy superior to that of alternative therapies. Three of these studies presented conventional pair-wise meta-analyses, but none included a network meta-analysis and none compared all potential first line therapies.