Real-life clinical data for dexamethasone and ranibizumab in the treatment of branch or central retinal vein occlusion over a period of six months

  • Sibylle WinterhalterEmail author
  • Annabelle Eckert
  • Gerrit-Alexander vom Brocke
  • Alice Schneider
  • Dominika Pohlmann
  • Daniel Pilger
  • Antonia M. Joussen
  • Matus Rehak
  • Ulrike Grittner
Retinal Disorders



To evaluate the therapeutic outcome for dexamethasone implant (DEX) or intravitreal ranibizumab (IVR) injections over 6 months in patients with macular edema due to branch or central retinal vein occlusion (BRVO, CRVO), in a real-life setting.


A total of 107 patients with BRVO or CRVO were included into this retrospective single-center observational study. Patients were treated with monotherapy consisting of DEX or three monthly IVR injections following a pro re nata regimen (PRN). Best-corrected visual acuity (BCVA), central retinal thickness (CRT) and intraocular pressure (IOP) were compared between the two therapy groups after 1, 3 and 6 months.


BRVO patients treated with DEX achieved a statistically significant gain in BCVA measured in logMAR after 1 month (mean gain, 95% CI: 0.21, 0.08–0.34, p = 0.001), 3 months (0.16, 0.03–0.28, p = 0.012) and 6 months (0.19, 0.07–0.32, p = 0.002), whereas patients treated with IVR showed a statistically significant BCVA gain in month 3 (mean improvement, 95% CI: 0.13, 0.01–0.26, p = 0.039) and month 6 (0.16, 0.03–0.29, p = 0.018). BCVA in CRVO patients with DEX worsened slightly at month 6 (mean worsening, 95% CI: −0.08, −0.24 to 0.08, p = 0.305), while IVR treated-patients achieved a statistically significant BCVA gain at 3 months (mean improvement, 95% CI: 0.14, 0.02–0.25, p = 0.021). Both therapies were accompanied by statistically significant CRT reductions of 150 to 200 μm (median). Adverse events reported were predictable and limited.


In a clinical setting, comparable improvement in BCVA and CRT were observed after DEX and IVR injections for treatment of BRVO. CRVO patients showed greater benefit with IVR.


Dexamethasone Ranibizumab Branch retinal vein occlusion Central retinal vein occlusion Macular edema Real-world data 



We thank Dr. Patricia Buchholz for her advice.

Compliance with ethical standards

For this type of study, formal consent is not required.

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.


  1. 1.
    Haller JA, Bandello F, Belfort R, Blumenkranz MS, Gillies M, Heier J, Loewenstein A, Yoon YH, Jarques ML, Jiao J, Li XY, Whitcup SM, OZURDEX GENEVA Study Group (2010) Randomized, sham- controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology 117:1134–1146CrossRefPubMedGoogle Scholar
  2. 2.
    Campochiaro PA, Heier JS, Feiner L (2010) Ranibizumab for macular edema following branch retinal vein occlusion. Six-month primary end point results of a phase III study. Ophthalmology 117:1102–1112CrossRefPubMedGoogle Scholar
  3. 3.
    Brown DM, Campochiaro PA, Singh RP (2010) Ranibizumab for macular edema following central retinal vein occlusion. Six-month primary end point results of a phase III study. Ophthalmology 117:1124–1133CrossRefPubMedGoogle Scholar
  4. 4.
    Winterhalter S, vom Brocke GA, Klamann MK, Müller B, Joussen AM (2015) Monthly microperimetry (MP1) measurement of macular sensitivity after dexamethasone implantation (Ozurdex) in retinal vein occlusions. Graefes Arch Clin Exp Ophthalmol 253(11):1873–1882CrossRefPubMedGoogle Scholar
  5. 5.
    Mathew R, Pearce E, Muniraju R, Abdul-Hey A, Sivaprasad S (2014) Monthly OCT monitoring of Ozurdex for macular oedema related to retinal vascular diseases: re-treatment strategy (OCTOME report 1). Eye 28(3):318–326CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Querques L, Querques G, Lattanzio R, Gigante SR, Del Turco C, Corradetti G, Cascavilla ML, Bandello F (2013) Repeated intravitreal dexamethasone implant (Ozurdex) for retinal vein occlusion. Ophthalmologica 229(1):21–25CrossRefPubMedGoogle Scholar
  7. 7.
    Augustin AJ, Holz FG, Haritoglou C, Mayer WJ, Bopp S, Scheuerle AF, Maier M, Sekundo W, Sandner D, Shirlaw A, Hattenbach LO (2015) Retrospective, observational study in patients receiving a dexamethasone intravitreal implant 0.7mg for macular oedema secondary to retinal vein occlusion. Ophthalmologica 233:18–26. CrossRefPubMedGoogle Scholar
  8. 8.
    Hattenbach LO, Feltgen N, Bertelmann T et al (2017) Head-to-head comparison of ranibizumab PRN versus single-dose dexamethasone for branch retinal vein occlusion (COMRADE-B). Acta Ophthalmol.
  9. 9.
    Hoerauf H, Feltgen N, Weiss C, Paulus EM, Schmitz-Valckenberg S, Pielen A, Puri P, Berk H, Eter N, Wiedemann P, Lang GE, Rehak M, Wolf A, Bertelmann T, Hattenbach LO, COMRADE-C Study Group (2016) Clinical efficacy and safety of Ranibizumab versus Dexamethasone for central retinal vein occlusion (COMRADE C): a European label study. Am J Opthamol.
  10. 10.
    IVAN Study Investigators, Chakravarthy U, Harding SP et al (2012) Ranibizumab versus bevacizumab to treat neovascular age-related macular degeneration: one-year findings from the IVAN randomized trial. Ophthalmology 119:1399–1411CrossRefGoogle Scholar
  11. 11.
    Lotery AJ, Gibson J, Cree AJ et al (2013) Pharmacogenetic associations with vascular endothelial growth factor inhibition in participants with neovascular age-related macular degeneration in the IVAN study. Ophthalmology 120:2637–2643CrossRefPubMedGoogle Scholar
  12. 12.
    Bach M, Kommerell G (1998) Determining visual acuity using European normal values: scientific principles and possibilities for automatic measurement. Klin Monatsbl Augenheilkd 212(4):190–195CrossRefPubMedGoogle Scholar
  13. 13.
    Sugrue MF (1996) The preclinical pharmacology of dorzolamide hydrochloride, a topical carbonic anhydrase inhibitor. J Ocul Pharmacol Ther 12(3):363–376CrossRefPubMedGoogle Scholar
  14. 14.
    Park HY, Lee NY, Kim JH et al (2008) Intraocular pressure lowering, change of antiapoptotic molecule expression, and neuroretinal changes by dorzolamide 2%/timolol 0.5% combination in a chronic ocular hypertension rat model. J Ocul Pharmacol Ther 24(6):563–571CrossRefPubMedGoogle Scholar
  15. 15.
    Călugăru D, Călugăru M (2015) Intravitreal bevacizumab in acute central/ hemicentral retinal vein occlusions: three-year results of a prospective clinical study. J Ocul Pharmacol Ther 31(2):78–86CrossRefPubMedGoogle Scholar
  16. 16.
    Mayer WJ, Haritoglou A, Wolf A et al (2015) Comparison of Intravitreal Dexamethasone implant versus Intravitreal Ranibizumab as a first-line treatment of macular Oedema due to retinal vein occlusion. Klin Monatsbl Augenheilkd 232(11):1289–1296CrossRefPubMedGoogle Scholar
  17. 17.
    Chiquet C, Dupuy C, Bron AM et al (2015) Intravitreal dexamethasone implant versus anti-VEGF injection for treatment-naïve patients with retinal vein occlusion and macular edema: a 12-month follow-up study. Graefes Arch Clin Exp Ophthalmol 253(12):2095–2102CrossRefPubMedGoogle Scholar
  18. 18.
    Yumusak E, Buyuktortop N, Ornek K (2016) Early results of dexamethasone implant, ranibizumab, and triamcinolone in macular edema due to branch retinal vein occlusion. Eur J Ophthalmol 26(1):54–59CrossRefPubMedGoogle Scholar
  19. 19.
    Eter N, Mohr A, Wachtlin J et al (2016) Dexamethasone intravitreal implant in retinal vein occlusion: real-life data from a prospective, multicentre clinical trial. Graefes Arch Clin Exp Ophthalmol 255(1):77–87CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Korobelnik JF, Kodjikian L, Delcour C et al (2016) Two-year, prospective, multicentre study of the use of dexamethasone intravitreal implant for treatment of macular edema secondary to retinal vein occlusion in the clinical setting in France. Graefes Arch Clin Exp Ophthalmol 254(12):2307–2318CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Bezatis A, Spital G, Höhn F et al (2013) Functional and anatomical results after a single intravitreal Ozurdex injection in retinal vein occlusion: a 6-month follow-up – the SOLO study. Acta Ophthalmol 91(5):e340–e347CrossRefPubMedGoogle Scholar
  22. 22.
    Capone A Jr, Singer MA, Dodwell DG et al (2014) Efficacy and safety of two or more dexamethasone intravitreal implant injections for treatment of macular edema related to retinal vein occlusion (Shasta study). Retina 34(2):342–351CrossRefPubMedGoogle Scholar
  23. 23.
    Lip PL, Malick H, Damer K et al (2015) One-year outcome of bevacizumab therapy for chronic macular edema in central and branch retinal vein occlusions in real-world clinical practice in the UK. Clin Ophthalmol 25(9):1779–1784CrossRefGoogle Scholar
  24. 24.
    Narayanan R, Panchal B, Das T et al (2015) A randomised, double-masked, controlled study of the efficacy and safety of intravitreal bevacizumab versus ranibizumab in the treatment of macular oedema due to branch retinal vein occlusion: MARVEL report no.1. Br J Ophthalmol 99(7):954–959CrossRefPubMedGoogle Scholar
  25. 25.
    Larsen M, Waldstein SM, Boscia F et al (2016) Individualized Ranibizumab regimen driven by stabilization criteria for central retinal vein occlusion: twelve-month results of the CRYSTAL study. Ophthalmology 123(5):1101–1111CrossRefPubMedGoogle Scholar
  26. 26.
    Farinha C, Marques JP, Almeida E et al (2015) Treatment of retinal vein occlusion with Ranibizumab in clinical practice: longer-term results and predictive factors of functional outcome. Ophthalmic Res 55(1):10–18CrossRefPubMedGoogle Scholar
  27. 27.
    Campochiaro PA, Sophie R, Pearlman J et al (2014) Long-term outcomes in patients with retinal vein occlusion treated with ranibizumab: the RETAIN study. Ophthalmology 121(1):209–219CrossRefPubMedGoogle Scholar
  28. 28.
    Brynskov T, Kemp H, Sørensen TL (2014) Intravitreal ranibizumab for retinal vein occlusion through 1 year in clinical practice. Retina 34(8):1637–1643CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Sibylle Winterhalter
    • 1
    Email author
  • Annabelle Eckert
    • 1
    • 2
  • Gerrit-Alexander vom Brocke
    • 1
  • Alice Schneider
    • 3
  • Dominika Pohlmann
    • 1
  • Daniel Pilger
    • 1
  • Antonia M. Joussen
    • 1
  • Matus Rehak
    • 1
    • 4
  • Ulrike Grittner
    • 3
  1. 1.Department of Ophthalmology, Campus Virchow-KlinikumCharité – University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of HealthBerlinGermany
  2. 2.Ophthalmicus AugentagesklinikVillingen-SchwenningenGermany
  3. 3.Department of Biostatistics and Clinical EpidemiologyCharité – University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of HealthBerlinGermany
  4. 4.Department of OphthalmologyUniversitätsklinikum LeipzigLeipzigGermany

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