Observation of the efficacy of ranibizumab combined with dexamethasone intravitreal implant in the treatment of retinal vein occlusion-associated macular edema
Abstract
Purpose: To observe the short-term efficacy and safety of ranibizumab combined with dexamethasone intravitreal implant (DEX) in the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO) (RVO-ME), with a focus on biomechanical changes in retinal vascular and tissue dynamics. Methods: A prospective clinical case study was conducted. A total of 88 patients (88 eyes) with RVO-ME were included in the study. According to the treatment strategy, they were divided into the DEX and ranibizumab combination group (combination group), the DEX group, and the ranibizumab group, with 33 eyes, 24 eyes, and 31 eyes, respectively. Patients underwent best-corrected visual acuity (BCVA), spectral domain optical coherence tomography (SD-OCT), optical coherence tomography angiography (OCTA), contrast sensitivity (CS), and visual field testing. The combination group received DEX one week after the first ranibizumab injection, while the other groups followed standard regimens. Follow-up assessments were conducted at 1 week, 2 weeks, and monthly for 6 months. Results: All groups showed significant improvements in BCVA, the retinal thickness (CRT), superficial and deep macular vascular density (SVC-MVD) and macular vascular density of deep macular vascular complex (DVC-MVD), mean defect of light sensitivity (MD), contrast sensitivity (CS), compared to baseline (P < 0.001). The combination group demonstrated superior vascular microstructure improvement, with better SVC-MVD and DVC-MVD at multiple time points (P < 0.05). Biomechanical analysis revealed enhanced vascular compliance and hemodynamic stability in the combination group, contributing to its efficacy. The average injection frequency was lower in the combination group (4.39 ± 0.55) compared to the ranibizumab group (4.65 ± 0.92, P < 0.05). Adverse events included subconjunctival hemorrhage and transient intraocular pressure elevation, with no serious complications. Conclusion: The combined group had a more significant effect in improving vascular microstructure, good short-term efficacy, could reduce the number of injections, and had better safety. The biomechanical benefits, including improved vascular compliance and hemodynamics, highlight its potential for optimizing retinal microcirculation.
References
1. Babiuch AS, Han M, Conti FF, et al. Association of Disorganization of Retinal Inner Layers With Visual Acuity Response to Anti–Vascular Endothelial Growth Factor Therapy for Macular Edema Secondary to Retinal Vein Occlusion. JAMA Ophthalmology. 2019; 137(1): 38. doi: 10.1001/jamaophthalmol.2018.4484
2. Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association, Ophthalmologist Branch of Chinese Medical Association. Expert consensus on clinical diagnosis and treatment path of retinal vein occlusion in China. Chinese Journal of Ophthalmology. 2024; 40(3): 175-185.
3. Rattner A, Williams J, Nathans J. Roles of HIFs and VEGF in angiogenesis in the retina and brain. Journal of Clinical Investigation. 2019; 129(9): 3807-3820. doi: 10.1172/jci126655
4. Xu M, Fan R, Fan X, et al. Progress and Challenges of Anti-VEGF Agents and Their Sustained-Release Strategies for Retinal Angiogenesis. Drug Design, Development and Therapy. 2022; 16: 3241-3262. doi: 10.2147/dddt.s383101
5. Noma H, Yasuda K, Mimura T, et al. Relationship Between Choroidal Findings And Growth Factors, Cytokines, And Other Inflammatory Mediators After Intravitreal Ranibizumab Injection In Patients With Macular Edema Secondary To Branch Retinal Vein Occlusion. Retina. 2022; 42(4): 744-751. doi: 10.1097/iae.0000000000003362
6. Zhou Y, Qi J, Liu H, et al. Increased intraocular inflammation in retinal vein occlusion is independent of circulating immune mediators and is involved in retinal oedema. Frontiers in Neuroscience. 2023; 17. doi: 10.3389/fnins.2023.1186025
7. Tang Y, Cheng Y, wang S, et al. Review: The development of risk factors and cytokines in retinal vein occlusion. Front med (Lausanne). 2022; 9: 910600. doi: 10.3389/fmed. 2022.910600.
8. Liang X, Shen B, Ou Z, et al. Comparison of intravitreal ranibizumab monotherapy vs. ranibizumab combined with dexamethasone implant for macular edema secondary to retinal v ein occlusion. Front med (Lausanne). 2022; 9: 930508. doi: 10.3389/fmed.2022. 930508
9. Blanc J, Deschasse C, Kodjikian L, et al. Safety and long-term efficacy of repeated dexamethasone intravitreal implants for the treatment of cystoid macular edema secondary to retinal vein occlusion with or without a switch to anti-VEGF agents: a 3-year experience. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2018; 256(8): 1441-1448. doi: 10.1007/s00417-018-4016-7
10. Maturi RK, Glassman AR, Liu D, et al. Effect of Adding Dexamethasone to Continued Ranibizumab Treatment in Patients With Persistent Diabetic Macular Edema. JAMA Ophthalmology. 2018; 136(1): 29. doi: 10.1001/jamaophthalmol.2017.4914
11. Hoerauf H, Feltgen N, Weiss C, et al. Clinical Efficacy and Safety of Ranibizumab Versus Dexamethasone for Central Retinal Vein Occlusion (COMRADE C): A European Label Study. American Journal of Ophthalmology. 2016; 169: 258-267. doi: 10.1016/j.ajo.2016.04.020
12. Khayat M, Williams M, Lois N. Ischemic retinal vein occlusion: characterizing the more severe spectrum of retinal vein occlusion. Survey of Ophthalmology. 2018; 63(6): 816-850. doi: 10.1016/j.survophthal.2018.04.005
13. Hayreh SS. Photocoagulation for retinal vein occlusion. Progress in Retinal and Eye Research. 2021; 85: 100964. doi: 10.1016/j.preteyeres.2021.100964
14. Wang B, Zhang X, Chen H, et al. A Review of Intraocular Biomolecules in Retinal Vein Occlusion: Toward Potential Biomarkers for Companion Diagnostics. Frontiers in Pharmacology. 2022; 13. doi: 10.3389/fphar.2022.859951
15. Gao S, Zhang Y, Li X, et al. Comparative Efficacy of Pharmacotherapy for Macular Edema Secondary to Retinal Vein Occlusion: A Network Meta-analysis. Frontiers in Pharmacology. 2021; 12. doi: 10.3389/fphar.2021.752048
16. Massa H, Georgoudis P, Panos GD. Dexamethasone Intravitreal Implant (OZURDEX ® ) for Macular Edema Secondary to Noninfectious Uveitis: a Review of the Literature. Therapeutic Delivery. 2019; 10(6): 343-351. doi: 10.4155/tde-2019-0024
17. Koss MJ, Pfister M, Rothweiler F, et al. Comparison of cytokine levels from undiluted vitreous of untreated patients with retinal vein occlusion. Acta Ophthalmologica. 2011; 90(2). doi: 10.1111/j.1755-3768.2011.02292.x
18. Ding X, Hu Y, Yu H, et al. Changes of Optical Coherence Tomography Biomarkers in Macular Edema Secondary to Retinal Vein Occlusion After Anti-VEGF and Anti-Inflammatory Therapies. Drug Design, Development and Therapy. 2022; 16: 717-725. doi: 10.2147/dddt.s351683
19. Ren F, Gong H, Zhang H, et al. Combination Therapy Using Anti-Vascular Endothelial Growth Factor (VEGF) Drugs and Steroids for Macular Edema in Retinal Vein Occlusions. Medical Science Monitor. 2023; 29. doi: 10.12659/msm.939277
20. Du X, Sheng Y, Shi Y, et al. The Efficacy of Simultaneous Injection of dexamethasone Implant and Ranibizumab Into Vitreous Cavity on Macular Edema Secondary to Central Reti nal Vein Occlusion. Front Pharmacol. 2022; 13: 842805. doi: 10.3389/fphar.2022. 842805.
21. Iu LP, Zhao P, Yeung IY, et al. Sequential therapy with ranibizumab and dexamethasone intravitreal implant is better than dexamethasone monotherapy for macular oedema due to retinal vein occlusion. British Journal of Ophthalmology. 2014; 99(2): 210-214. doi: 10.1136/bjophthalmol-2014-305661
22. Costanzo E, Parravano M, Gilardi M, et al. Microvascular Retinal and Choroidal Changes in Retinal Vein Occlusion Analyzed by Two Different Optical Coherence Tomography Angiography Devices. Ophthalmologica. 2019; 242(1): 8-15. doi: 10.1159/000496195
23. Ghasemi Falavarjani K, Iafe NA, Hubschman JP, et al. Optical Coherence Tomography Angiography Analysis of the Foveal Avascular Zone and Macular Vessel Density After Anti-VEGF Therapy in Eyes With Diabetic Macular Edema and Retinal Vein Occlusion. Investigative Opthalmology & Visual Science. 2017; 58(1): 30. doi: 10.1167/iovs.16-20579
24. Ruan Y, Yao D, Shi Y. Clinical study of ranibizumab combined with dexamethasone intravitreal implant in the treatment of macular edema secondary to retinal vein occlusion. China Journal of Clinical Pharmacology. 2023; 39(23): 3397-3400. doi: 10.13699/J.CNKI.1001-6821
25. Wang J, Cui Y, Vingopoulos F, et al. Disorganisation of retinal inner layers is associated with reduced contrast sensitivity in retinal vein occlusion. British Journal of Ophthalmology. 2020; 106(2): 241-245. doi: 10.1136/bjophthalmol-2020-317615
26. Chin EK, Almeida DRP, Velez G, et al. Ocular hypertension after intravitreal dexamethasone (Ozurdex) sustained-release implant. Retina. 2017; 37(7): 1345-1351. doi: 10.1097/IAE. 0000000000001364
27. Flaxel CJ, Adelman RA, Bailey ST, et al. Retinal Vein Occlusions Preferred Practice Pattern®. Ophthalmology. 2020; 127(2): P288-P320. doi: 10.1016/j.ophtha.2019.09.029
28. Zarranz-Ventura J, Sala-Puigdollers A, Velazquez-Villoria D, et al. Long-term probability of intraocular pressure elevation with the intravitreal dexamethasone implant in the real-world. Vavvas DG, ed. PLOS ONE. 2019; 14(1): e0209997. doi: 10.1371/journal.pone.0209997
Copyright (c) 2025 Author(s)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright on all articles published in this journal is retained by the author(s), while the author(s) grant the publisher as the original publisher to publish the article.
Articles published in this journal are licensed under a Creative Commons Attribution 4.0 International, which means they can be shared, adapted and distributed provided that the original published version is cited.
Submit a Paper
