Objective <p>This study aimed to evaluate and compare the clinical efficacy of intravitreal ranibizumab (RNZ) and intravitreal dexamethasone (DEX) implants in the treatment of retinal vein occlusion (RVO) complicated with macular oedema (MO).</p> Methods <p>Five English-language databases were searched from database establishment to August 2025. In this study, the RevMan 5.3 statistical software package was used.</p> Results <p>A total of 10 articles involving 1,274 patients were included. A meta-analysis showed that intravitreal RNZ was superior to intravitreal DEX implants in improving visual acuity in patients with RVO complicated by MO. In patients with central RVO (CRVO), best-corrected visual acuity (BCVA) improved more significantly in the RNZ-treated group than in the DEX group at 6 months (<i>p</i> &lt; 0.001). For patients with branch RVO (BRVO), the RNZ group showed better BCVA improvement than the DEX group at both 1 and 3 months (<i>p</i> &lt; 0.001). Best-corrected visual acuity had improved more at 1 month in the RNZ group (<i>p</i> &lt; 0.001) than in the DEX group. Ranibizumab was superior to DEX in reducing central retinal thickness (CRT) at 3 months in patients with BRVO and in those with CRVO. Patients with BRVO showed a significant decline in CRT at 3 months (<i>p</i> &lt; 0.001) and 6 months (<i>p</i> = 0.005), and patients with CRVO also had a significant improvement in CRT at 6 months (<i>p</i> = 0.005). However, intraocular pressure was higher in the intravitreal DEX group than in the RNZ group (<i>p</i> &lt; 0.001).</p> Conclusion <p>Intravitreal RNZ is superior to intravitreal DEX implants in improving BCVA and reducing CRT in patients with RVO complicated with MO; however, RNZ is injected more frequently. These findings are primarily derived from short-to-medium-term evidence, highlighting a need for longer-term comparative data. Furthermore, it should be noted that most included studies did not stratify outcomes by ischaemic status, which is a relevant clinical consideration.</p>