Comparison of dexamethasone intravitreal implant with intravitreal anti-VEGF injections for the treatment of macular edema secondary to branch retinal vein occlusion

Abstract

Abstract Background: This meta-analysis compared the efficacy and safety of dexamethasone intravitreal implant (DEX) and anti-vascular endothelial growth factor (anti-VEGF) in the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods: The PubMed, Embase, Cochrane Library, and Web of Science databases were comprehensively searched for published studies comparing DEX with anti-VEGF for the treatment of ME caused by BRVO. Outcomes of the selected studies included best-corrected visual acuity (BCVA), central macular thickness (CMT), and adverse events. Review Manager (RevMan) 5.3 was used to analyze the data. Results: Six trials comparing the efficacy and safety of DEX with anti-VEGF were included in this meta-analysis. At 1 month, DEX achieved a mean BCVA superior to that achieved by anti-VEGF (MD\u200a=\u200a−0.11, P\u200a<\u200a.0001), in addition to a superior mean BCVA change (MD\u200a=\u200a−0.35, P\u200a<\u200a.00001). At 3 months, the mean BCVA showed a significant difference (MD\u200a=\u200a−0.06, P\u200a=\u200a.03) between DEX and anti-VEGF treatment, while the mean BCVA change was similar to that with anti-VEGF treatment (MD\u200a=\u200a−0.06, P\u200a=\u200a.11). However, neither mean BCVA nor mean BCVA change showed a significant difference between DEX and anti-VEGF treatment at 6 months (MD\u200a=\u200a0.08, P\u200a=\u200a.06; MD\u200a=\u200a0.06, P\u200a=\u200a.43, respectively). Mean CMT and mean CMT change were significantly lower in the DEX group than in the anti-VEGF group at 1 month (MD\u200a=\u200a−53.63 μm, P\u200a<\u200a.00001; MD\u200a=\u200a−60.1 μm, P\u200a=\u200a.005, respectively). However, at 3 months, mean CMT and mean CMT change were similar between DEX and anti-VEGF treatment (MD\u200a=\u200a17.4 μ, P\u200a=\u200a.74; MD\u200a=\u200a18.01 μm, P\u200a=\u200a.72, respectively). Although mean CMT in the anti-VEGF group was not significantly lower than that in the DEX group at 6 months (MD\u200a=\u200a55.53, P\u200a=\u200a.07), the mean CMT change from baseline achieved by the anti-VEGF treatment was significantly superior to that obtained with DEX (MD\u200a=\u200a75.53, P\u200a=\u200a.0002). Concerning adverse events, no statistically significant differences were observed in the incidence of cataract (OR\u200a=\u200a4.25, P\u200a=\u200a.07), but the use of DEX led to a higher risk of intraocular pressure elevation compared with anti-VEGF treatment (OR\u200a=\u200a12.04, P\u200a=\u200a.006). Conclusions: Our results show that visual acuity recovery and CMT were better in the DEX group than in the anti-VEGF group after 1 and 3 months, although the difference in CMT at 3 months was not significant. However, there were no significant differences in terms of visual acuity and CMT between the two groups after 6 months of follow-up. Therefore, DEX may be recommended as the first treatment option in ME associated with BRVO.