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Corticosteroid intravitreal implants vs. ranibizumab for the treatment of vitreoretinal disease

Comyn, Olivera,c,d; Lightman, Sue L.c,d; Hykin, Philip G.b,c

Current Opinion in Ophthalmology: May 2013 - Volume 24 - Issue 3 - p 248–254
doi: 10.1097/ICU.0b013e32835fab27
RETINAL, VITREOUS AND MACULAR DISORDERS: Edited by Gary C. Brown
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Purpose of review 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.

Recent findings 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.

Summary 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.

aNIHR Biomedical Research Centre

bMedical Retina Department

cMoorfields Eye Hospital NHS Foundation Trust

dUCL Institute of Ophthalmology, London, UK

Correspondence to Mr Philip G. Hykin, FRCOphth, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK. Tel: +44 207 253 3411; e-mail: philhykin@aol.com

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins