Clinical Observation Of Ranibizumab Combined With Ozurdex In The Treatment Of Macular Edema Secondary To Branch Retinal Vein Occlusion

Objective: To evaluate the efficacy and safety of dexamethasone intravitreal implant（Ozurdex）combined with Ranibizumab,Ranibizumab and Ozurdex in the treatment of macular edema secondary to branch retinal vein occlusion（BRVO-ME）.Methods: 46 patients（eyes）with BRVO-ME diagnosed in the Department of Ophthalmology of the First Affiliated Hospital of Bengbu Medical College from December 2019 to September 2021 were divided into Ranibizumab group（22 eyes）,Ozurdex group（11 eyes）and combined group（13 eyes）.Before treatment and 1,2,3,4,6 and 12 months after treatment,all patients were tested for best corrected visual acuity（BCVA）,optical coherence tomography（OCT）,central macular thickness（CMT）,intraocular pressure（IOP）and adverse events.BCVA,CMT,IOP,injection times and postoperative adverse reactions were observed and compared among the three groups before and after treatment.Results:1.The average CMT before treatment was significantly different from 1 month,2months,3 months,4 months,6 months and 12 months after treatment in the Ranibizumab group,Ozurdex group and combination group（all P < 0.05）.2.The average BCVA（Log MAR）before treatment was significantly different from 1month,2 months,3 months,4 months,6 months and 12 months after treatment in the Ranibizumab group and the combination group（all P<0.05）;The average BCVA（Log MAR）before treatment in Ozurdex group was significantly different from that at 1 month,2 months,3 months,6 months and 12 months after treatment（all P<0.05）.while the average BCVA（Log MAR）at 4 months after treatment was not significantly different from that before treatment（P > 0.05）.3.There was no significant difference between the average IOP before treatment and 1month,2 months,3 months,4 months,6 months and 12 months after treatment in Ranibizumab group（all P > 0.05）;The average IOP of Ozurdex group and combined group before treatment was significantly different from that of 1 month,2 months,3 months and 6 months after treatment（all P < 0.05）,but there was no significant difference from that of 4 months and 12 months after treatment（all P > 0.05）.4.Compared with Ozurdex group at the same time point,there was significant difference in average CMT at 4 and 12 months after treatment in Ranibizumab group and combined group（all P < 0.05）.There was no significant difference in CMT between Ranibizumab group and combined group at the same time（P > 0.05）.5.There were significant differences in BCVA（Log MAR）between Ranibizumab group and combined group at 4 and 12 months after treatment and Ozurdex group at the same time point（all P < 0.05）.There was no significant difference in BCVA（Log MAR）between Ranibizumab group and combined group at the same time point after treatment（all P > 0.05）.6.The average number of injections was 7.91±1.23 in Ranibizumabb group,2.82±0.75 in Ozurdex group and 4.15 ± 1.21 in combination group.There were significant differences in the number of injections among Ranibizumab group,Ozurdex group and combined group（all P < 0.05）.7.Cataract progression was observed in 4 eyes of the Ozurdex group and 3 eyes of the combined group,while no obvious cataract progression was observed in Ranibizumab group.IOP ≥ 25 mm Hg was observed in 3 patients in the Ozurdex group and 1 patient in the combined group in February,and IOP ≥ 25 mm Hg was observed in 3 patients in the Ozurdex group and 4 patients in the combined group in June.All patients with elevated intraocular pressure were treated with drugs to reduce the intraocular pressure to normal.None of the patients had severe ocular side effects such as vitreous hematosis,retinal detachment and endophthalmitis.Conclusions:1.Compared with single drug Ranibizumab,Ranibizumab combined with Ozurdex has the same therapeutic effect in the treatment of BRVO-ME,but the combined treatment can reduce the number of injections.2.The treatment of BRVO-ME with Ranibizumab or Ozurdex is safe and effective in improving vision and reducing macular edema.3.The efficacy of Ranibizumab combined with Ozurdex or single drug Ranibizumab in the treatment of BRVO-ME is more obvious than Ozurdex in improving BCVA and reducing CMT.4.The main complication of Ozurdex in the treatment of BRVO-ME is the increase of IOP.We need to pay close attention to the changes of intraocular pressure after implantation.