Abstract
BackgroundRetinal vein occlusion (RVO) is a common retinal venous disorder that causes vision loss. No specific therapy has been developed. Controversy exists regarding two treatments: intravitreal dexamethasone implants and anti-vascular endothelial growth factor (VEGF). The goal of this study is to compare the effectiveness and safety of dexamethasone implants and anti-VEGF treatment for RVO.MethodsThe PubMed, Embase, and Cochrane Library databases were searched for studies comparing dexamethasone implants with anti-VEGF in patients with RVO. Best-corrected visual acuity (BCVA), central subfield thickness (CST), intraocular pressure changes, conjunctival haemorrhage, reduced VA, and macular oedema were extracted from the final included studies. RevMan 5.3 was used to conduct the quantitative analysis and bias assessment.ResultsFour randomised controlled trials assessing 969 eyes were included. The anti-VEGF treatment showed better BCVA improvement (mean difference [MD] = − 10.59, P < 0.00001) and more CST decrease (MD = − 86.71 μm, P = 0.02) than the dexamethasone implants. However, the dexamethasone implants required fewer injections. As for adverse effects, the dexamethasone implants showed significantly higher intraocular pressure (IOP) and more cataracts than the anti-VEGF treatment. No significant differences were found in conjunctival haemorrhage, reduced VA, and macular oedema.ConclusionsAnti-VEGF treatment showed better functional and anatomical improvement with less risk of IOP elevation and cataract formation compared to dexamethasone implants. Thus, anti-VEGF treatment is the first choice for treating RVO patients.
Highlights
Retinal vein occlusion (RVO) is a common retinal venous disorder that causes vision loss
As these pathological characteristics always lead to macular oedema and vitreous haemorrhage secondary to neovascularization of the retina, vision loss in RVO patients is mainly caused by these two conditions [7]
As the data were provided separately in this study, we split it into two independent studies by Feltgen (b) and Feltgen (c) (b for branch retinal vein occlusion (BRVO) and c for central retinal vein occlusion (CRVO))
Summary
Retinal vein occlusion (RVO) is a common retinal venous disorder that causes vision loss. The central retinal artery, which shares the same adventitial sheath with the adjacent central retinal vein, may compress the vein and lead to occlusion, especially in eyes with increased arterial rigidity from hypertension and arteriosclerosis [5] Both BRVO and CRVO share an identical pathology, an increase (2019) 19:8 in the intravascular pressure in the obstructed vein and damage to the vessel wall, which result in fluid leakage and the release of inflammatory cytokines such as vascular endothelial growth factor (VEGF), respectively [6]. As these pathological characteristics always lead to macular oedema and vitreous haemorrhage secondary to neovascularization of the retina, vision loss in RVO patients is mainly caused by these two conditions [7]
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