A comparison of three different intravitreal treatment modalities of macular edema due to branch retinal vein occlusion.

Abstract

To compare the efficacy of intravitreal injection of ranibizumab, dexamethasone implant and aflibercept for the management of macular edema (ME) related to branch retinal vein occlusion (BRVO). This retrospective and comparative study included 62 eyes of 62 patients with BRVO and ME. Patients received one of the following treatments: 0.5mg ranibizumab (group 1, n=22), 0.7mg dexamethasone implant (group 2, n=20) and 2mg aflibercept (group 3, n=20). The 6-month treatment protocol in groups 1 and 3 consisted of 3-dose loading treatment for the first 3months and followed by repeat injections based on clinical necessity. Group 2 received only single dose of 0.7mg dexamethasone implant for 6months. Visual acuity (VA), central macular thickness (CMT), serous retinal detachment (SRD) height and intraocular pressure (IOP) measurements were done at baseline and first 6months of follow-up. At baseline, the groups did not differ in age, gender, duration of ME, VA, CMT, IOP and SRD height (p>0.05). Mean number of injections per eye within six months were 3.64±0.49 (range 3-4) in group 1, only 1 in group 2 and 3.35±0.49 (range 3-4) in group 3.VA was significantly better in group 2 in first 3months but it became the worst among three groups in sixth month. CMT did not differ between groups in first 3months, but it was significantly higher in group 2 at sixth month. SRD height was significantly lower in group 2 in first 3months, but there was no difference between the groups at the end of the sixth month. IOP was significantly higher in group 2 in third and sixth months. In the treatment of ME associated with BRVO, dexamethasone implant appears to be more advantageous in terms of VA and SRD height for the first 3months. However, at the end of the sixth month of treatment, anti-VEGF drugs were more efficient in maintaining the increased visual acuity and reduced CMT. A dexamethasone implant may be the first treatment option in BRVO cases with high SRD.