Abstract:

Objective To explore the clinical efficacy of dexamethasone intravitreal implant (DEX-I) combined with ranibizumab in the treatment of macular edema (ME) secondary to retinal vascular diseases. Methods The data of 116 patients with ME secondary to diabetic retinopathy (DR) or retinal vein occlusion (RVO) were retrospectively analyzed. Based on different treatment methods, patients were assigned to the DEX-I group (n=39, 0.7 mg of DEX-I was injected into the vitreous cavity, with subsequent dosing as needed after a single treatment), the ranibizumab group (n=37, 0.05 mL of ranibizumab was injected into the vitreous cavity, once a month for 3 consecutive months, followed by dosing as needed), and the combined group (n=40, 0.05 mL of ranibizumab was injected into the vitreous cavity, followed by 0.7 mg of DEX-I injected into the vitreous cavity 1 week later, with subsequent dosing as needed after a single treatment). The central macular thickness (CMT), best corrected visual acuity (BCVA), intraocular pressure (IOP), and the levels of miR-146a, miR-377-3p and vascular endothelial growth factor (VEGF) in aqueous humor were compared between the three groups. Adverse events and the number of injections were recorded. Results After 1, 2, 3 and 6 months of treatment, CMT was lower in the combined group than that in the DEX-I group and the ranibizumab groups (P<0.05)，and CMT of the DEX-I group was smaller than that of the ranibizumab group after 1 and 2 months of treatment (P<0.05). After 1, 2, 3 and 6 months of treatment, the BCVA was lower in the combined group than that of the DEX-I group and the ranibizumab group (P<0.05), and there was no significant difference in IOP between the three groups (P>0.05). After 6 months of treatment, the combined group exhibited higher levels of miR-146a and miR-377-3p and lower VEGF level in aqueous humor compared to those of the DEX-I group and the ranibizumab group (P<0.05). There was no significant difference in incidence of adverse events between the three groups (P>0.05). The number of injections was higher in the combined group and the ranibizumab group than that in the DEX-I group (P<0.05). Conclusion DEX-I combined with ranibizumab can reduce CMT in patients with ME secondary to retinal vascular diseases, improve visual acuity and levels of miR-146a and miR-377-3p in the aqueous humor, inhibit VEGF levels, and the safety is controllable.

Key words: macular edema, diabetic retinopathy, retinal vein occlusion, dexamethasone, dexamethasone intravitreal implant, ranibizumab