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

PURPOSE: 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).

METHODS

This retrospective and comparative study included 62 eyes of 62 patients with BRVO and ME. Patients received one of the following treatments: 0.5 mg ranibizumab (group 1, n = 22), 0.7 mg dexamethasone implant (group 2, n = 20) and 2 mg aflibercept (group 3, n = 20). The 6-month treatment protocol in groups 1 and 3 consisted of 3-dose loading treatment for the first 3 months and followed by repeat injections based on clinical necessity. Group 2 received only single dose of 0.7 mg dexamethasone implant for 6 months. Visual acuity (VA), central macular thickness (CMT), serous retinal detachment (SRD) height and intraocular pressure (IOP) measurements were done at baseline and first 6 months of follow-up.

RESULTS

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 3 months but it became the worst among three groups in sixth month. CMT did not differ between groups in first 3 months, but it was significantly higher in group 2 at sixth month. SRD height was significantly lower in group 2 in first 3 months, 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.

CONCLUSION

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 3 months. 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.