Comparison of Efficacy of Intravitreal Dexamethasone Implant versus Ranibizumab Biosimilar for Macular Edema Secondary to Branch Retinal Vein Occlusion

Aim: The aim of this study was to compare the efficacy of intravitreal sustained-release dexamethasone implant with intravitreal ranibizumab biosimilar in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods: In this prospective randomized study, we included 18 patients (mean age 57.6 ± 8.35 years; range 50–76 years; 11 males) with treatment-naïve ME with BRVO. Patients received ranibizumab biosimilar ( n = 7) or dexamethasone implant ( n = 11) injections and were followed up after 1 month, then monthly for up to 6 months. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), and subfoveal choroidal thickness (SCT) on swept-source optical coherence tomography. Results: At 1 month, both groups showed improvement in BCVA compared to baseline, with the ranibizumab biosimilar group showing greater improvement (0.01 ± 0.17 vs. 0.33 ± 0.32) ( P = 0.04). IOP was significantly lower in eyes treated with ranibizumab biosimilar (18.3 ± 3.15 mmHg vs. 15.4 ± 2.0 mmHg) ( P = 0.04). Both groups noted a reduction in CMT and SCT, but the difference between the two groups was not significant. At the last recorded follow-up, both groups showed improvement in BCVA, but the difference between the groups was not significant. Final CMT and change in CMT were also not significantly different between the two groups. There was a trend toward greater reduction in SCT in eyes treated with dexamethasone implant (˗36.14 ± 43.4 vs. ˗3.18 ± 29.1 μm) ( P = 0.07). Ranibizumab biosimilar was significantly more cost-effective, in terms of vision gain and cost, by a factor of 2487:1. Conclusions: Ranibizumab biosimilar may be a cost-effective alternative to dexamethasone implant.