| Objective:This study provides evidence for clinical application and benefits patients more,by comparing the efficacy and safety of dexamethasone intravitreal implant(Ozurdex)and anti-VEGF drug(ranibizumab)in the treatment of macular edema secondary to retinal vein occlusion(RVO-ME).Methods:This study was a prospective randomized controlled study.Fifty patients(50 eyes)who were first diagnosed with RVO-ME in the Ophthalmology Department of the Affiliated Hospital of North Sichuan Medical College from December 2020 to December 2021 were included in this study according to the inclusion criteria.They were randomly divided into the DEX group(n=26),which received Ozurdex intravitreal injection with 1+PRN regimen,and the anti-VEGF group(n=24),which received ranibizumab intravitreal injection with 3+PRN regimen.Before treatment and at the 1st week、1m、2m、3m、6m after treatment,the detection indexes include best corrected vision acuity(BCVA)、intraocular pressure(IOP)、central macular thickness(CMT)、area of foveal avascular zone(FAZ)、blood flow density of super capillary plexus(SCP)、horizontal metamorphopsia(HM)、vertical metamorphopsia(VM)、contrast sensitivity(CS)、mean deviation(MD)、the number of intravitreal injections、lens status and various adverse effects.All data were professionally analyzed in SPSS25.0 using chi-square test、paired sample t-test、independent sample t-test analysis and rank-sum test analysis.All statistical results were set P<0.05 as Statistical significant.Results:BCVA、CMT、CS、HM、VM and MD in the two groups were significantly improved in the first week after operation(P<0.05).In addition to the anti VEGF group,the FAZ area was larger than that before operation at 1w(P<0.05),there was no significant change in FAZ area and SCP vascular density at other time points(P>0.05).The efficacy in the DEX group could be maintained for about three months,the second month after drug injection was the peak efficacy,and the efficacy in the anti-VEGF group could be maintained for about one month.When comparing the two groups,at 1w,the mean difference in FAZ area of the anti-VEGF group was greater than that of the DEX group(P<0.05).At 2 m,the mean difference in HM was greater in the anti-VEGF group than in the DEX group(P<0.05);The mean difference in CMT and CS was greater in the DEX group than in the anti-VEGF group(P<0.05).At 3 m,the mean difference in BCVA and CMT in the anti-VEGF group was greater than that in the DEX group(P<0.05);The mean difference in VM in the anti-VEGF group was greater than that in the DEX group(P<0.05).At 6m,the mean difference in MD and VM was greater in the anti-VEGF group than in the DEX group(P<0.05).The risk of injection(31%increase in IOP,4%cataract progression,19%subconjunctival hemorrhage)was higher in the DEX group than in the anti-VEGF group(4%increase in IOP,0%cataract progression,17%subconjunctival hemorrhage),in which the risk of IOP elevation differed significantly(P<0.05).The number of injections in the DEX group(1.88± 0.33 times),which was less than that in the anti VEGF group(3.92± 0.76 times),may reduce the injection risk and patient economic burden to some extent.Conclusions:Both ranibizumab and Ozurdex were effective in alleviating macular edema in RVO-ME patients,with the most rapid reductions in central macular thickness,central visual field mean deviation and improvements in branch retinal vein occlusion and contrast sensitivity in the first week.There was no significant improvement in foveal avascular zone or superficial retinal vessel density over the 6-month follow-up period.None experienced major complications during treatment,and Ozurdex was associated with a higher risk of IOP elevation,fewer injections,and longer maintenance than ranibizumab. |
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