title: Corticosteroid intravitreal implants vs. ranibizumab for the treatment of vitreoretinal disease.
abstract: OBJECTIVE
  Three long-acting corticosteroid implants are now available for the treatment of retinal disease, offering control of macular edema and inflammation for between 6 months and up to 3 years. This review evaluates their efficacy and side-effect profile in comparison with the antivascular endothelial growth factor agent ranibizumab in diabetic macular edema, retinal vein occlusion, pseudophakic macular edema, and uveitis.
  
  
  RESULTS
  Trials of ranibizumab in diabetic macular edema have demonstrated excellent efficacy without serious safety concerns to date. Fluocinolone acetonide implants can be considered, but have a high risk of cataract and sequelae from intraocular pressure rise. In retinal vein occlusion, both ranibizumab and Ozurdex have been shown to be effective, although their relative efficacy has not been determined in head-to-head clinical trials. In pseudophakic and uveitic macular edema, steroid implants are probably the first choice therapy, although there is evidence that ranibizumab is effective. For choroidal neovascularization secondary to inflammatory disease, ranibizumab is indicated, whereas Retisert has been shown to reduce the risk of uveitis relapse.
  
  
  CONCLUSIONS
  In diabetic macular edema, ranibizumab has shown greater efficacy with fewer side-effects than steroid implants. Both ranibizumab and steroid implants can be considered in retinal vein occlusion, but trials are awaited to determine their relative efficacy.
authors.affiliation: NIHR Biomedical Research, UCL Institute of Ophthalmology, Ujniversity College London, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Comyn
authors.forename: Sue L
authors.initials: SL
authors.lastname: Lightman
authors.forename: Philip G
authors.initials: PG
authors.lastname: Hykin
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000503:physiopathology; D004343:Drug Implants; D005446:Fluocinolone Acetonide / Q000009:adverse effects / Q000627:therapeutic use; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008269:Macular Edema / Q000188:drug therapy* / Q000503:physiopathology; D000069579:Ranibizumab; D012170:Retinal Vein Occlusion / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014605:Uveitis / Q000188:drug therapy* / Q000503:physiopathology; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D004343:Drug Implants; D005938:Glucocorticoids; D005446:Fluocinolone Acetonide; D000069579:Ranibizumab