Clinical use of Dexamethasone Implants in Resistant Macular Edema Secondary to Branch Retinal Vascular Occlusion compared with Intravitreal Anti-Vascular Endothelial Growth Factor

Abstract

Branch retinal vein occlusion (BRVO) is the second most common type of retinal vascular disorder. Both inflammation and increased vascular endothelial growth factor (VEGF) levels play important roles in the pathogenesis of macular edema (ME) secondary to BRVO. The aim of this study was to compare the efficacy of 0.7-mg intravitreal dexamethasone implants with continued anti-VEGF treatment in patients with ME secondary to BRVO who were poor responders to at least 6 previous anti-VEGF injections. Methods: Patients exhibiting an insufficient response to at least 6 ranibizumab treatments and who subsequently underwent a dexamethasone implant were included Group 1. Patients who were at risk for cataract or glaucoma continued treatment with the same drug and were defined as Group 2. The best corrected visual acuity (BCVA) and central macular thickness (CMT) changes at month 2, 4, and 6 were measured. Results: Ninety eyes were evaluated. In Group 1, the mean baseline BCVA of 0.71±0.75 logarithm of the minimum angle of resolution (logMAR) improved to 0.53±0.62 logMAR at month 2 (p<.001), 0.67±0.72 logMAR at month 4 (p=0.325), and 1.03±0.83 logMAR at month 6 (p=.001). In Group 2, the mean baseline BCVA was 0.73±0.83 logMAR, and improved to 0.68±0.83 logMAR at month 2 (p=0.12), 0.698±0.81 logMAR at month 4 (p=0.270), and 0.76±0.80 at month 6 (p=0.546). The baseline CMT in each group was 588±176 μm and 545±165 μm, respectively (p=0.248). The mean CMT of Group 1 changed from a baseline measurement of 588±176 μm to 308±132 μm at month 2 (p<.001), 450±195 μm at month 4 (p<.001), and 510±190 μm at month 6 (p<.001). The mean CMT of Group 2 changed from a baseline value of 545±165 μm to 486±162 μm at month 2 (p<.001), 516±168 μm at month 4 (p<.001), and 528±171 μm at month 6 (p=0.037). Conclusion: Dexamethasone implants were a more effective treatment for patients with BRVO-related resistant ME than ranibizumab at month 2. However, this positive effect seems to decline rapidly in the long term.

One Intravitreal Dexamethasone Implant versus Multiple Intravitreal Injections of Triamcinolone Acetonide for Post-Surgical Macular Edema: Efficacy and Safety

“…[18] Several studies have shown that ITA is a safe option as it has rare rise in IOP that is usually transient and easy to control [19], [21], [30]- [33], similar to our study.…”

Comparison of intravitreal dexamethasone implant and intravitreal ranibizumab efficacy in younger patients with branch retinal vein occlusion

“…In the MEAD study, cataract related to a single injection did not develop, and 70% of cataracts developed after four injections (19). Similarly, in another study, Eris et al (20) reported that during the 6 months of follow-up after a single dose of DEX for the treatment of BRVO, no patient developed cataract. The reason for the absence of cataract in our study may be that a single DEX implant was applied.…”

“…At baseline the median IOP was 14 (9-20) mmHg in the DEX group and 13 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) in the RAN group (p=0.518). Figure 3 shows the median IOP alteration in each group over time.…”