Three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent-onset branch retinal vein occlusion

Alireza Ramezani, Hamed Esfandiari, Morteza Entezari, Siamak Moradian, Masoud Soheilian, Babak Dehsarvi, Mehdi Yaseri
Graefe's Archive for Clinical and Experimental Ophthalmology 2012, 250 (8): 1149-60

PURPOSE: To evaluate the effects of repeated intravitreal injections of bevacizumab (IVB) versus triamcinolone acetonide (IVT) in the treatment of acute branch retinal vein occlusion (BRVO).

METHODS: In this randomized clinical trial, 86 eyes with recent-onset (less than 12 weeks) BRVO were included. Participants were randomly assigned to two treatment groups: (1) IVB group (43 eyes), patients who received three monthly injections of 1.25 mg of IVB, and (2) IVT group (43 eyes), patients who received two injections of 2 mg IVT 2 months apart. Patients were examined at 1, 2, 3, 4, and 6 months after enrollment. Main outcome measure was change in best-corrected visual acuity (BCVA) at 6 months. Secondary outcome measures were central macular thickness (CMT) and intraocular pressure (IOP) changes at month 6.

RESULTS: Mean BCVA improved significantly up to 6 months in both groups from 0.68 ± 0.25 to 0.31 ± 0.21 logMAR (logarithm of minimum angle of resolution) in the IVB group, and from 0.67 ± 0.29 to 0.46 ± 0.31 logMAR in the IVT group (P < 0.001 for both). However, between-group differences reach to a significant level at months 4 (P = 0.013) and 6 (P < 0.001) in favor of the IVB group. In terms of CMT reduction, similarly, both groups showed a significant decrease at months 3 and 6, and the differences between the groups were statistically significant (P = 0.031) at final visit. Dividing the cases into ischemic and non-ischemic types, a significant difference was noted only in the ischemic cases regarding BCVA improvement and CMT reduction in favor of the IVB group. Mean IOP rise was significantly higher in the IVT group at all visits.

CONCLUSIONS: Both 3-times-monthly IVB injections and 2-times IVT injections with a 2-month interval could be effective for improving BCVA and CMT in cases with recent-onset BRVO up to 6 months. However, considering the better visual and anatomic outcomes after IVB injections and the potential complications of IVT injections, we would recommend prescheduled repeated IVB injections for such cases. The favorable responses were more pronounced in the ischemic types of BRVO in this trial; nevertheless, this should be confirmed in larger studies.

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