Macular edema (ME) is a prevalent complication of diabetic retinopathy (DR) and retinal vein occlusion (RVO) that contributes significantly to vision impairment worldwide. This condition is primarily driven by elevated vascular endothelial growth factor (VEGF) and pro-inflammatory cytokines, resulting in the use of anti-VEGF agents such as aflibercept and corticosteroids such as dexamethasone implants. However, evidence comparing the clinical efficacy and safety of these two modalities remains limited. This systematic review and meta-analysis aimed to compare the safety and efficacy of intravitreal aflibercept injections and dexamethasone implants in ME associated with DR and RVO. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD42024577212). A comprehensive search of the PubMed, Cochrane, Web of Science, and Scopus databases was performed until August 30, 2024. Nine studies, involving 572 eyes, were included in the analysis. Key outcomes assessed included Best-Corrected Visual Acuity (BCVA), Central Retinal Thickness (CRT), and Intraocular Pressure (IOP). A random-effects model was applied to the pooled effect size calculations, and heterogeneity was addressed using sensitivity analyses. Both treatments showed comparable efficacy in improving BCVA and reducing CRT across follow-up intervals. At 3 months, dexamethasone implants demonstrated statistically significant superiority in BCVA improvement (MD = 1.18, 95% CI [0.89, 1.47], P < 0.001) and CRT reduction (MD = − 62.45 µm, 95% CI [− 85.67, − 39.22], P < 0.001) compared to aflibercept. Similarly, at 12 months, dexamethasone implants maintained greater efficacy in CRT reduction (MD = − 58.73 µm, 95% CI [− 78.12, − 39.34], P < 0.001). However, dexamethasone implants were associated with an increased IOP at 3 and 6 months (MD = 1.04 mmHg, 95% CI [0.56, 1.52], P < 0.001). No significant differences in IOP were observed between treatments at 12 months. Intravitreal aflibercept injections and dexamethasone implants are effective modalities for the management of ME, with each presenting distinct advantages. Dexamethasone implants minimize the frequency of treatment, while achieving superior outcomes in terms of BCVA and CRT. However, they are also associated with a heightened risk of IOP elevation and cataract formation. Conversely, aflibercept requires more frequent administration, which may result in logistical and financial challenges for patients and health care providers. Therefore, personalized treatment strategies should consider disease severity, comorbidities, and individual preferences. Future research should prioritize patient-centered outcomes, emphasizing quality of life and treatment costs while also investigating condition-specific responses to these therapeutic interventions.

Background: Alien Hand Syndrome (AHS) is a rare neurological disorder characterized by involuntary, complex movements of a limb, often with a sense of estrangement from the affected hand. Initially described in 1908, AHS has since been associated with various neurological conditions, including strokes, neurodegenerative diseases, tumors, and surgical interventions affecting the corpus callosum and frontal lobes. Objective: This study aims to provide a comprehensive review of etiology, clinical manifestations, neuroanatomical basis, and differential diagnosis of AHS, synthesizing findings from published case reports and literature. Methods: This scoping review followed PRISMA-ScR guidelines to systematically analyze AHS case reports from PubMed (2010–2025). Two independent reviewers screened studies using predefined criteria, extracting demographic, clinical, neuroimaging, and treatment data. Eligible case reports required a confirmed AHS diagnosis with complete clinical and neuroimaging documentation. Data synthesis combined descriptive statistics and qualitative analysis to map AHS characteristics across subtypes. Results: A total of 72 cases were reviewed, with a mean patient age of 59.58 years (SD 18.24), ranging from 9 to 89 years. Males accounted for 48.6% (35 cases), while females represented 51.4% (37 cases). The most frequently implicated brain regions were the corpus callosum, supplementary motor area, and posterior parietal cortex. AHS was commonly associated with stroke, neurodegenerative diseases (e.g., corticobasal syndrome, Creutzfeldt-Jakob disease), and brain tumors. The disorder was categorized into three subtypes, each with distinct clinical presentations and underlying neuropathology. Differential diagnoses included psychiatric disorders, movement disorders, and body schema disturbances. Conclusion: AHS remains a rare and complex neurological disorder with diverse etiologies and clinical manifestations. Accurate diagnosis requires thorough clinical evaluation and neuroimaging to differentiate AHS from psychiatric and other neurological conditions. Further research is needed to elucidate its pathophysiology and develop targeted therapeutic approaches.