Background: central retinal vein occlusion (CRVO), a common retinal vascular disorder, is characterized by dilated and tortuous retinal veins with hemorrhages in all four quadrants of the retina, CRVO can reduce vision severely, and its prevalence is estimated at 0.80 per 1000 persons. Purpose: Comparing the efficacy and safety of intravitreal ranibizumab versus dexamethasone implant (DEX) in patients with macular oedema secondary to CRVO. Patients and Methods: a prospective randomized comparative study was performed at Al-Azhar University hospitals on forty eyes in thirty-four patients presented by macular oedema secondary to CRVO included in this study, divided into two equal groups: Group (1) included 20 eyes with intravitreal ranibizumab for six months and group (2) included 20 eyes with dexamethasone implant for six months. Results: in group (1) visual acuity improved and CMT decreased slightly but not significantly after 1 month to 0.25±0.12 and 335.3±75.5 μM, respectively. After 6 months of follow-up, the mean BCVA had significantly increased to 0.73±0.4 (P=0.007) and retinal thickness had significantly decreased to 271.3±145 μM. In group (2) visual acuity improved and CMT decreased slightly after 1 month to 0.25±0.13and 480.35±185.25 μM, respectively. After 6 months of follow-up, the mean BCVA had significantly increased to 0.63±0.3 (P=0.008) and retinal thickness had significantly decreased to 290.3±155 μM Conclusion: intraocular injections of 0.7mg ranibizumab provided rapid, effective treatment for macular edema following CRVO, and patients who do not respond to consecutive anti-VEGF treatment may benefit from switching the therapy to dexamethasone implant.