First Author: B.Yuksel TURKEY
Co Author(s): O. Karti S. Kerci O. Celik T. Kusbeci
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To make a real-world comparison of the efficacy of ranibizumab, dexamethasone and grid laser treatments in macular edema (ME) due to branch retinal vein occlusion (BRVO).
In this retrospective study, 44 eyes of 44 consecutive patients with ME secondary to BRVO were included. Treatment arms comprised standard care (StCARE, n=15), intravitreal ranibizumab (RNB, n=14) and dexamethasone implant (DEX, n=15). 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. No rescue laser was performed in DEX and RNB groups. Main outcome measures were mean change in Best corrected visual acuity (BCVA), central retinal thickness (CRT) and the percentage of patients who gained ≥10 letters from baseline to 6 months.
Improvements in mean logMAR BCVA (p= 0.642) and letter score from baseline to month 6 were not statistically significant in all three groups. 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). Percentage of patients who gained ≥10 letters was 66.7%, 42.8% and 26.7% respectively. Mean CRT at baseline was 512.8 µm in DEX, 505.1 µm in RNB and 345.5 µm in StCARE group. Vision improved in 73.3% of DEX, 64.2% of RNB and 35.7% of StCARE eyes. At the last visit, RNB provided the maximum reduction in CRT. Mean CRT decrease was -146.5 µm (28.6%) in DEX, -241.3 µm (47.8%) in RNB and -45.6 µm (13.2%) in StCARE (p= 0.030). A statistically significant intraocular pressure elevation occurred in DEX group (p= 0.005).
Both RNB and DEX provided a significant resolution in macular edema. Low frequency injections may limit the visual gain in ranibizumab therapy. Dexamethasone implants may be preferable in terms of visual improvement under low frequency injection conditions. Laser monotherapy is not a reasonable option in the era of injection therapies.