Combination of Ranibizumab, Dexamethasone Superior to Ranibizumab Alone for Macular Edema

Patients with macular edema secondary to non–ischemic retinal vein occlusion (RVO-ME) experienced superior clinical efficacy with a sequential therapy of ranibizumab (Lucentis; Genentech) and dexamethasone implant (Ozurdex; AbbVie) when compared with ranibizumab monotherapy, according to a new study.¹ This could provide a new treatment method with less burden for the patient.

RVO is an eye condition that could cause visual problems, which can be classified into either central RVO or branch RVO. The vision loss affecting patients with RVO is often due to ME, which is secondary to the RVO.² Intravitreal anti-vascular endothelial growth factor (anti-VEGF) is primarily used as the first-line therapy to treat RVO-ME, and the dexamethasone implant has also shown efficacy as an anti-inflammatory treatment. This study aimed to evaluate the efficacy of using ranibizumab and a dexamethasone implant therapy sequentially in patients diagnosed with RVO-ME.

Patients included in this study were treated for non-ischemic RVO-ME at Sanmenxia Eye Hospital from 2020 to 2024. Participants were aged 18 years or older, had a confirmed diagnosis of non-ischemic RVO-ME, had completed at least 9 months of follow-up, and had baseline measurements of central macular thickness (CMT) that were greater than 290 μm. Any participant who had a coexisting ocular condition, had macular edema caused by other etiologies, had data missing, had a history of vitreoretinal surgery, or had the presence of ischemic RVO was excluded.

Participants in the monotherapy group received 3 monthly intravitreal injections of ranibizumab consecutively before a pro re nata regimen. Those who received both received 1 injection of ranibizumab before a dexamethasone implant was installed within 2 to 4 weeks. Mean change in best corrected visual acuity (BCVA) and CMT acted as the primary end points. The frequency of injections and the usage of medicine were secondary end points for the combination group.

There were 139 eyes included in this study, of which 71 received the combination therapy. BCVA was improved in both groups in the first 2 months, but the combination group had a greater mean (SD) improvement (–0.44 [0.27] logMAR) when compared with the monotherapy group (–0.33 [0.31] logMAR) after 3 months; the combination group continued to be significantly better through 9 months (–0.53 [0.28] vs –0.37 [0.32] logMAR). The combination group also had more patients achieving visual gain that was greater than or equal to 0.3 logMAR through 9 months compared with the monotherapy group (81% vs 51%).

CMT reduction was also found in both groups, but the combination group had greater reduction compared with the monotherapy group through 2 months (290.83 [56.66] vs 321.26 [71.59] μm). Differences were not statistically significant at 3, 6, or 9 months, but the combination group had lower CMT throughout.

Adverse events were more common in the combination group, including more patients reporting elevation in intraocular pressure (26.8% vs 10.3%); all heightened intraocular pressure was treated and returned to normal by the end of follow-up without optic nerve damage.

There were limitations to this study. A statistical power calculation was not done for this analysis due to the retrospective and real-world nature of the study. Long-term analysis is not included in this study, as 9 months is not enough time to come to long-term conclusions.

The authors concluded that the combination of ranibizumab and dexamethasone is more effective than using ranibizumab alone for patients with RVO-ME. “Compared with anti-VEGF monotherapy, this combined regimen not only achieves superior long-term visual outcomes and faster resolution of macular edema but also significantly reduces injection frequency and the associated treatment burden,” the authors wrote.

References

1. Gao L, Cai X, Dang Y. Efficacy and safety of ranibizumab combined with dexamethasone intravitreal implant sequential therapy for macular edema secondary to non-ischemic retinal vein occlusion. Drug Des Devel Ther. 2026;20:604539. doi:10.2147/DDDT.S604539
2. Seminara L. RVO-related macular edema: baseline factors and outcomes. American Academy of Ophthalmology. June 2017. Accessed April 6, 2026. https://www.aao.org/eyenet/article/rvo-related-macular-edema