Differences between treatment groups were compared after adjusting for baseline characteristics (age, sex, CharlsonDeyo Comorbidity Index, health plan type, and US geographical region)

Differences between treatment groups were compared after adjusting for baseline characteristics (age, sex, CharlsonDeyo Comorbidity Index, health plan type, and US geographical region). non-treatment visits, and time intervals between visits. == Results == Overall, 2822 patients received ranibizumab injections (CRVO, 1178; BRVO, 1644) and 365 received dexamethasone implants (CRVO, 191; BRVO, 174). The mean number (SD) of all ophthalmology visits was higher for patients receiving ranibizumab injections than for those receiving dexamethasone implants (CRVO: 7. 2 (3. 6)vs6. 2 (3. 1), P <0. 001; BRVO: 7. 1 (3. 4)vs6. 3 (3. 1), P=0. 016). == Conclusions == Patients with RVO receiving ranibizumab injections had a mean of approximately one more visit to their ophthalmologist in the first 12 months of treatment than those treated with dexamethasone implants. The visit burden is therefore not HSPA1 substantially different and physicians should focus on the clinical benefits of these drugs when evaluating treatment options for RVO. == Introduction == Macular oedema (MO) secondary to retinal vein occlusion (RVO) is the second most common cause of retinal vascular disease, and can result in significant vision loss. 1, 2The pathogenesis of RVO is multifactorial, but the retinal veins typically become obstructed owing to vascular clots, external vascular compression or vessel wall pathology. 3The obstruction can occur in either the central retinal vein or branches of the retinal veins, and is referred to as central RVO (CRVO) and branch RVO (BRVO), respectively. 2BRVO is more common than CRVO, with prevalence estimates of 4. 42 per 1000 (95% confidence interval (CI): 3. Caffeic Acid Phenethyl Ester 655. 19) for BRVO compared with 0. 80 per 1000 (95% CI: 0. 610. 99) for CRVO. 4Occlusion of the retinal veins causes an increase in capillary pressure, which induces expression of vascular endothelial growth factor Caffeic Acid Phenethyl Ester (VEGF) and interleukin-6. 5, 6This causes a breakdown of the blood-retinal barrier and increases vascular permeability, 6leading to complications such as MO and retinal ischemia, ultimately resulting in vision loss. 3Until recently, the standard of care for MO secondary Caffeic Acid Phenethyl Ester to RVO comprised corticosteroids (CRVO and BRVO) and laser photocoagulation (BRVO only); 7however, anti-VEGF agents provide an additional therapeutic option for both BRVO and CRVO. 7, 8, 9, 10, 11 Ranibizumab (Lucentis) is a humanized, VEGF antibody fragment that binds and neutralizes multiple isoforms of VEGF. 11The efficacy and safety of ranibizumab intravitreal injection were assessed in two randomized, phase three clinical trials (BRAVO and CRUISE, ClinicalTrial. gov IdentifiersNCT00486018andNCT00485836, respectively), in which patients with BRVO and CRVO were administered the study drug once per month for 6 months and compared with sham-treated individuals. 12, 13In both studies, a higher proportion of patients treated with ranibizumab experienced improvements in vision relative to baseline than individuals who received sham injections (P <0. 0001), as assessed by a gain of 15 or more letters in best corrected visual acuity (BCVA). This was accompanied by a higher mean (95% confidence interval) change in BCVA letter score from baseline in patients treated with ranibizumab than in those who received sham injections (18. 3 (16. 020. 6)vs7. 3 (5. 19. 5), respectively). 12, 13These improvements were maintained for up to 12 months. 14, 15Ocular adverse events also occurred at a lower frequency in the ranibizumab group than in the sham-treated group. 12, 13As a consequence, ranibizumab was approved for the treatment of MO secondary to RVO by the US Food and Drug Administration (FDA) in 2010 (ref. 16) and by the European Medicines Agency (EMA) in 2011. 17Clinical trial data were later supported by a series of real-world evidence studies, which provided further evidence supporting the effectiveness and safety profile of ranibizumab for the treatment of patients with retinal disease. 18, 19, 20The recommended dose of ranibizumab in patients with CRVO and BRVO is 0. 5 mg (0. 05 ml solution) administered as a single intravitreal injection once per month in the USA. 21 Dexamethasone, a water-soluble corticosteroid, has also been shown to be efficacious in the treatment of patients with CRVO and BRVO. 22Dexamethasone is delivered directly to the vitreous cavity by an intravitreal implant (Ozurdex). 23A sham-controlled clinical trial (GENEVA, ClinicalTrial. gov IdentifierNCT01660802) of dexamethasone implant demonstrated significant improvements in BCVA scores and in the percentage of eyes with an improvement of at least 15 letters in BCVA in patients with CRVO and BRVO, compared with sham-treated patients, from day 30 to day 90 after treatment initiation (P <0. 001). 22However, results from this trial have also shown that the incidence of ocular adverse events was significantly higher in patients treated with dexamethasone implant than in sham-treated individuals. 22, 24 A recent study by Lamet alprovided evidence that dexamethasone implant also provides real-world anatomical and functional improvements in patients with MO associated with retinal disease. 25Furthermore, this study.