Low frequency ranibizumab versus dexamethasone implant for macular oedema secondary to branch retinal vein occlusion

The aim was to make a real-world comparison of the efficacy of ranibizumab, dexamethasone and grid laser treatments in macular oedema due to branch retinal vein occlusion (BRVO).

Forty-four eyes of 44 consecutive patients with macular oedema secondary to BRVO were included. Treatment arms comprised standard care (StCARE, n = 15), intravitreal ranibizumab (RNB, n = 14) and dexamethasone implant (DEX, n = 15). No rescue laser was performed in DEX and RNB groups. Main outcome measures were mean change in visual acuity (VA) and the percentage of patients who gained 10 or more letters from baseline to six months and central retinal thickness (CRT).

Improvements in mean logMAR VA (p = 0.642) and letter score from baseline to month 6 were not statistically significantly different in all three groups. Mean follow-up was 13.9 ± 10.7 months in RNB, 11.9 ± 6.3 in DEX and 11.4 ± 6.6 in StCARE. Mean number of injections was 2.4 ± 1.4 (range: 1-6) in RNB and 1.9 ± 0.7 (range: 1-3) in DEX group over the follow-up period. Mean letter gain was 13.5 in DEX (p = 0.067), 7.1 in RNB (p = 0.553) and 4.5 in StCARE (p = 0.362). Mean CRT at baseline was 512.8 μm in DEX, 505.1 μm in RNB and 345.5 μm in the StCARE group. At the last visit, RNB provided the maximum reduction in CRT. Mean CRT decrease was -146.5 μm (28.6 per cent) in DEX, -241.3 μm (47.8 per cent) in RNB and -45.6 μm (13.2 per cent) in StCARE (p = 0.030). A statistically significant intraocular pressure elevation occurred in the DEX group (p = 0.005).

Both RNB and DEX provided a significant resolution in macular oedema. Low frequency injections limited the visual gain in ranibizumab therapy. Visual results could be better with higher frequency injections and early start of treatment. Dexamethasone implants may be preferable in terms of visual improvement under low frequency injection conditions. Close follow-up is mandatory for detection of intraocular pressure elevations. Laser monotherapy is not a reasonable first-line option in the era of injection therapies.