First Author: I.Wong HONG KONG
Co Author(s): I. Yeung N. Fung I. Wong 0 0 0 0 0 0 0 0 0
Back to previous
To evaluate the efficacy and safety of combination therapy with intravitreal ranibizumab followed by dexamethasone implant as compared to dexamethasone implant alone in the treatment of macular oedema (MO) due to retinal vein occlusions (RVO).
Department of Ophthalmology, Queen Mary Hospital, Hong Kong
This was a retrospective, comparative, interventional study. Patients with MO secondary to RVO treated at the Department of Ophthalmology, Queen Mary Hospital from June 2012 to November 2013 were reviewed. The treatments of interest were (1) combination therapy of ranibizumab followed by dexamethasone implant and (2) dexamethasone implant alone. The inclusion criteria were: (a) baseline central foveal thickness (CFT) ≥ 300µm and (b) post-treatment follow up for at least 6 months. Patients were excluded if they had macular laser within 3 months or intravitreal triamcinolone acetonide within 6 months before the treatments of interest. Eligible patients were divided into two groups for main analyses: Group 1 patients had intravitreal ranibizumab followed by dexamethasone implant within 6 weeks of injection (combination therapy group); Group 2 patients had dexamethasone implant alone (dexamethasone monotherapy group). The primary outcome measure was the proportion of patients who had visual acuity (VA) gain of at least 1 line on Snellen chart (functional success) and resolution of MO with CFT <300µm (anatomical success) within 6 months after treatment. Secondary outcome measures included the time to achieve VA gain, duration of MO resolution and safety of treatments.
A total of 37 eyes of 37 patients were included, of which 54% had central RVO and 46% had branch RVO. The mean age of patients was 75.1 ± 9.4 years. The mean baseline CFT was 628 ± 231µm. There were 18 patients in group 1 (combination therapy group) and 19 patients in group 2 (dexamethasone monotherapy group). Within 6 months after treatment, there were more patients in group 1 who had VA gain of at least 1 line than in group 2 (50% vs 32%, P=0.242). In subgroup analysis, group 1 patients were more likely to have VA gain of at least 2 lines (44% vs 5%, P=0.008) and at least 3 lines (22% vs 0%, P=0.046) compared with group 2 and the differences were statistically significant. VA gain occurred faster in group 1. Group 1 patients were more likely to have resolution of MO than in group 2 (85% vs 74%, P=0.451). There were more patients in group 1 who had no recurrence of MO at 6 months (17% vs 5% P=0.340). Recurrence of MO occurred later in group 1.
Combination therapy with ranibizumab followed by dexamethasone implant was more likely and was faster to result in VA gain than dexamethasone implant alone. Combination therapy delayed the recurrence of MO. The chance of having at least 2 lines and 3 lines of VA gain was significantly better after combination therapy. In summary, combination therapy with ranibizumab followed by dexamethasone implant provides additional benefit to dexamethasone implant alone in MO due to RVO.