Comparison Of Dexamethasone Intravitreal Implant With Intravitreal Anti-Vegf Injections For The Treatment Of Macular Edema Secondary To Branch Retinal Vein Occlusion A Meta-Analysis

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= -0.11, P<.0001), in addition to a superior mean BCVA change (MD= -0.35, P<.00001). At 3 months, the mean BCVA showed a significant difference (MD= -0.06, P=.03) between DEX and anti-VEGF treatment, while the mean BCVA change was similar to that with anti-VEGF treatment (MD= -0.06, P=.11). However, neither mean BCVA nor mean BCVA change showed a significant difference between DEX and anti-VEGF treatment at 6 months (MD=0.08, P=.06; MD=0.06, P=.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= -53.63 mu m, P<.00001; MD=-60.1 mu m, P=.005, respectively). However, at 3 months, mean CMT and mean CMT change were similar between DEX and anti-VEGF treatment (MD= 17.4 mu, P=.74; MD=18.01 mu m, P=.72, respectively). Although mean CMT in the anti-VEGF group was not significantly lower than that in the DEX group at 6 months (MD=55.53, P=.07), the mean CMT change from baseline achieved by the anti-VEGF treatment was significantly superior to that obtained with DEX (MD=75.53, P=.0002). Concerning adverse events, no statistically significant differences were observed in the incidence of cataract (OR=4.25, P=.07), but the use of DEX led to a higher risk of intraocular pressure elevation compared with anti-VEGF treatment (OR=12.04, P=.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.