Intravitreal ranibizumab versus dexamethasone implant in macular edema due to branch retinal vein occlusion: Systematic review and meta-analysis

Purpose: Intravitreal ranibizumab (RNB) and dexamethasone intravitreal implant (DII) were developed in the recent past and has been widely used for macular edema secondary to BRVO. We aimed to assess the efficacy and safety of intravitreal ranibizumab (RNB) compared to dexamethasone intravitreal implant (DII) in patients with macular edema secondary to branch retinal vein occlusion (BRVO). Methods: We performed a comprehensive search on topics that assess RNB and DII in patients with macular edema secondary to BRVO from several electronic databases. Results: There were 678 subjects from five studies. Ranibizumab was associated with a greater increase in best-corrected visual acuity (BCVA; mean difference 9.13, I 2 : 0%) compared to DII. Ranibizumab also demonstrated a greater ⩾10 (OR 2.76, I 2 : 0%) and ⩾15 letters (OR 2.78, I 2 : 0%) gain. RNB has better BCVA (logMAR scale) improvement at 6 months’ follow up (mean difference −0.15, I 2 : 64%) in favor of RNB. Higher IOP was found in DII group on follow-up (mean difference −2.92, I 2 : 89%) and RNB has lesser IOP ⩾10 mmHg increase compared to DII (OR 0.08, I 2 : 0%). Cataract formation and/or progression was less in RNB (OR 0.53, I 2 : 75%). The need for rescue laser was similar the two groups. Conclusion: Intravitreal RNB was more effective with less pronounced effect on IOP and cataract formation and/or progression compared to DII for patients with macular edema secondary to BRVO.