title: Efficacy and safety of intravitreal therapy in macular edema due to branch and central retinal vein occlusion: a systematic review.
abstract: BACKGROUND
  Intravitreal agents have replaced observation in macular edema in central (CRVO) and grid laser photocoagulation in branch retinal vein occlusion (BRVO). We conducted a systematic review to evaluate efficacy and safety outcomes of intravitreal therapies for macular edema in CRVO and BRVO.
  
  
  RESULTS
  MEDLINE, Embase, and the Cochrane Library were systematically searched for RCTs with no limitations of language and year of publication. 11 RCTs investigating anti-VEGF agents (ranibizumab, bevacizumab, aflibercept) and steroids (triamcinolone, dexamethasone implant) with a minimum follow-up of 1 year were evaluated.
  Greatest gain in visual acuity after 12 months was observed both under aflibercept 2 mg: +16.2 letters (8.5 injections), and under bevacizumab 1.25 mg: +16.1 letters (8 injections). Ranibizumab 0.5 mg improved vision by +13.9 letters (8.8 injections). Triamcinolone 1 mg and 4 mg stabilized visual acuity at a lower injection frequency (-1.2 letters, 2 injections).
  Ranibizumab 0.5 mg resulted in a visual acuity gain of +18.3 letters (8.4 injections). The effect of dexamethasone implant was transient after 1.9 implants in both indications.
  
  
  RESULTS
  Serious ocular adverse events were rare, e.g., endophthalmitis occurred in 0.0-0.9%. Major differences were found in an indirect comparison between steroids and anti-VEGF agents for cataract progression (19.8-35.0% vs. 0.9-7.0%) and in required treatment of increased intraocular pressure (7.0-41.0% vs. none). No major differences were identified in systemic adverse events.
  
  
  CONCLUSIONS
  Anti-VEGF agents result in a promising gain of visual acuity, but require a high injection frequency. Dexamethasone implant might be an alternative, but comparison is impaired as the effect is temporary and it has not yet been tested in PRN regimen. The ocular risk profile seems to be favorable for anti-VEGF agents in comparison to steroids. Because comparative data from head-to-head trials are missing currently, clinicians and patients should carefully weigh the benefit-harm ratio.
authors.affiliation: University Eye Hospital, Albert Ludwig University, Freiburg, Germany ; University Eye Hospital, Medical School of Hannover, Hannover, Germany.
authors.forename: Amelie
authors.initials: A
authors.lastname: Pielen
authors.forename: Nicolas
authors.initials: N
authors.lastname: Feltgen
authors.forename: Christin
authors.initials: C
authors.lastname: Isserstedt
authors.forename: Josep
authors.initials: J
authors.lastname: Callizo
authors.forename: Bernd
authors.initials: B
authors.lastname: Junker
authors.forename: Christine
authors.initials: C
authors.lastname: Schmucker
mesh_terms: D006801:Humans; D058449:Intravitreal Injections / Q000009:adverse effects; D008269:Macular Edema / Q000188:drug therapy* / Q000209:etiology*; D061214:Patient Safety; D012170:Retinal Vein Occlusion / Q000150:complications*; D018570:Risk Assessment