| Objective:To observe the short-term efficacy,safety and cost-effectiveness of Ranibizumab combined with dexamethasone Intravitreal implant(DEX)compared with Ranibizumab and DEX alone during the therapy of macular edema secondary to retinal vein occlusion(RVO-ME).Methods:A Retrospective clinical observation.From January 2020 to September2022,67 RVO-ME patients with 67 eyes diagnosed in the eye examination of Department of Ophthalmology of the Affiliated Hospital of Yanan University were included in the study.Dexamethasone(DEX)monotherapy group had 17 patients with 17 eyes,ranibizumab monotherapy group had 34 patients with 34 eyes and combination group had 16 patients with 16 eyes.DEX group had intravitreal injection of DEX(1+PRN)alone,ranibizumab group had intravitreal treatment of ranibizumab(3+PRN)only and combination group,was the combination of ranibizumab and DEX,DEX injection after 4 weeks of treatment of renibizumab.The re-therapy standard is CRT(Central Retinal Thickness)≥250um or visual acuity decreased by 6 letters of ETDRS.Data was collected about BCVA,CRT,IOP(Intraocular pressure),injection times,hospitalization expenses,follow-up costs and intravitreal injection related adverse events during 6 months follow-up.Results 1.BCVA The changes in BCVA after therapy in the three groups were statistically significant compared to baseline(P<0.05).The comparison of BCVA among the three groups: There were statistically significant differences in BCVA at 2 month,3month and 6 month among the three groups(P<0.05).Pairwise comparison between ranibizumab and DEX group showed that the improvement of BCVA was more obvious in the ranibizumab groups at 3 month and 6 month,and the difference was a statistical significance(P<0.05).The progress of BCVA was more apparent in the combination group compared with DEX group,which was a statistical significance(P<0.05).2.CRT The decrease of CRT after therapy among the three groups were statistically significant compared to baseline(P<0.05).CRT comparison between the three groups: There were statistically significant differences in CRT at one week and 3 month after treatment among the three groups(P<0.05).Pairwise comparison: After 1 week and 3 months of treatment,CRT of ranibizumab group improved significantly compared with the DEX group,and the difference was a statistical significance(P<0.05);Compared with DEX group,the improvement of CRT of ranibizumab was more obvious which was statistically significant(P<0.05).3.IOP The changes of IOP after treatment in the DEX group were statistically significant compared to baseline(P<0.05).About 23.5%patients had high IOP in the DEX group,which were controlled by IOP-lowering drugs.The changes of IOP in the ranibizumab group were not statistically significant(P>0.05).There was no patients with high IOP.In combination group,the increase of IOP at 3months was statistically significant(P<0.05).About 12.5% patients had high IOP in the combination group,which were controlled by IOP-lowering drugs.4.Adverse events At DEX group: 23.5% patients had high IOP and 23.5% had subconjunctival hemorrhage.There was no high IOP and 11.8% patients had subconjunctival hemorrhage at ranibizumab.In combination group,12.5% patients had high IOP and 18.75% patients had subconjunctival hemorrhage.5.Cost effectiveness The number of injections in DEX group,ranibizumab group and combination group was(2.24±0.83),(3.82±0.76)and(2.38±0.62),respectively,and the difference was statistically significant(P<0.05).The pairwise comparison: the number of injections of ranibizumab was about 1.7 times higher than DEX group and the number of injections of ranibizumab group was about 1.6 times higher than combination group which was statistically significant(P<0.05).Hospitalization expenses in DEX group,ranibizumab group and combination group were(14606.29±5555.26),(25417.24±4922.20)and(17279.63±3843.17)yuan,respectively,and the difference was statistically significant(P<0.05).The pairwise comparison :the hospitalization cost of ranibizumab group was about 1.7 times higher than DEX group,the hospitalization cost of ranibizumab group was about 1.5 times higher than the combination group,which was statistically significant(P<0.05).Conclusion Our study showed that combination injection of DEX and ranibizumab in the vitreous cavity could significantly improve the visual acuity and anatomic CRT without serious complications.What’s more,the combination strategy could save economic cost and relieve psychological stress of patients.Therefore,the combination of anti-VEGF and anti-inflammatory drugs plays a complementary and synergistic role,with good efficacy,safety and cost effect. |
PDF Full Text Request