Intravitreal Bevacizumab, Triamcinolone acetonide or Combined Treatment for Macular Edema Secondary to Branch Retinal Vein Occlusion

Abstract

Purpose: To evaluate the safety and efficacy of intravitreal injection of bevacizumab (IVB), triamcinolone acetonide (IVTA) or combined treatment (IVB+IVTA) for macular edema secondary to branch retinal vein occlusion (BRVO).

Methods: A prospective randomized interventional study on cases of BRVO. Fifty five eyes of 54 patients were included and divided into 3 groups. Group 1 included 20 eyes received IVB 2.5 mg/0.1 ml. Group 2 included 18 eyes received IVTA 4 mg/0.1 ml. Group 3 included 17 eyes received combined IVB 1.25 mg/0.05 ml and IVTA 2 mg/0.05ml. Central macular thickness (CMT) by optical coherence tomography (OCT), visual acuity (VA), intraocular pressure (IOP), number of injections and complications after injection were the main outcomes.

Results: Central macular thickness is significantly reduced after injection in the 1^st, 3^rd and 6^th month within the same group in the three groups (P<0.001). There was significant VA improvement in the 1^st, 3^rd and 6^th month after injection when compared to baseline VA within the same group in the three groups. There was significant IOP elevation in group 2 when compared to groups 1 and 3 in the 1^st week (p=0.02), 1^st month (p<0.001), 3^rd month (p<0.001) and 6^th month (p<0.001) after injection. Sixty five percent of eyes required more than one injection in group 1 compared to 16.7% in group 2 and 17.6% in group 3.

Conclusions: The three lines; IVB, IVTA and IVB+IVTA resulted in reduction of CMT and improvement of VA at all follow up visits. IVTA led to the best reduction in CMT but was associated with cataract and glaucoma formation. IVA led to the best VA but had the highest number of injections.

Key words: Branch retinal vein occlusion, Bevacizumab, Triamcinolone acetonide, Macular edema, Central macular thickness.