Abstract
Purpose :
To compare the efficacy and safety of intravitreal dexamethasone implant (DEX implant) and anti-VEGF agents in treating macular edema (ME) secondary to retinal vein occlusion (RVO).
Methods :
The databases of Pubmed, Embase, Cochrane, and the website of www.clinicaltrials.gov were searched for randomized clinical trial studies (RCTs) comparing the efficacy of DEX implant with anti-VEGF in RVO patients. Two researchers independently identified the eligible studies. Mean change of best-corrected visual acuity (BCVA) and central subfield thickness (CST) at month 6 and month 12, and adverse events data during the study were extracted from the final eligible studies. GRADE profiler was used to access the quality of studies. Review Manager (RevMan5.3) was used to synthesize the data either with random effect or fixed effect model according to the existence of heterogeneity.
Results :
Four eligible RCTs were identified for inclusion with a total of 854 eyes. One injection of DEX implant was inferior in improving visual acuity to standard frequency injection of anti-VEGF (mean BCVA difference [MD] = -7.12, P=0.004) at month 6. By adding another DEX implant and then pro re nata (PRN), better visual acuity was still achieved in anti-VEGF group (mean BCVA difference [MD]= -8.98, P< 0.001) at month 12. When come to anatomic outcome, Anti-VEGF showed similar efficacy at month 6 (mean CST difference [MD]=100.01, P=0.12) and marginally better efficacy at month 12 (mean CST difference [MD]=41.72, P=0.03) comparing with the DEX implant treatment. No statistically significant difference were found in terms of serious adverse events, while DEX implant had higher risk of intraocular pressure (IOP) elevation and cataract than anti-VEGF group.
Conclusions :
Comparing with anti-VEGF agents, DEX implant improved no better anatomical outcome and had inferior functional efficacy with higher incidence of adverse events such as IOP elevation and cataract. Although requiring fewer injection, the DEX implant still need to be dialectically used in treating ME secondary to RVO, especially in the first line treatment scenario.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.