In China, clinicians often use Chinese patent medicines (CPMs) as supportive therapy for diabetic retinopathy (DR). This study employed a network meta-analysis (NMA) to evaluate the comparative efficacy and safety of three CPMs combined with calcium dobesilate (CD) and to identify the most effective adjunctive treatment for DR.A Bayesian NMA framework was applied to examine both therapeutic outcomes and safety profiles of different CPM regimens in DR. The review protocol was registered in PROSPERO (CRD42022323996).Twenty-three randomized controlled trials involving 1,824 patients met the inclusion criteria. When compared with CD monotherapy, Compound Danshen Dripping Pills (DS) + CD and Qiming Granule (QM) + CD showed marked improvements in best-corrected visual acuity (BCVA). DS + CD and Compound Xueshuantong Capsule (XST) + CD led to significant reductions in macular thickness, while all CPM + CD combinations effectively decreased VEGF levels. Among the treatments, DS + CD and XST + CD outperformed QM + CD in lowering macular thickness. Safety analysis revealed no significant differences in adverse events among the CPMs or when compared with CD alone.DS + CD or QM + CD appear more effective for enhancing BCVA, while DS + CD and XST + CD show greater efficacy in reducing macular thickness. All CPM combinations were effective in lowering VEGF without increasing adverse events, suggesting DS + CD as a potentially preferred adjuvant therapy for DR.
