Korean J Ophthalmol.  2018 Feb;32(1):29-37. 10.3341/kjo.2016.0134.

Bevacizumab versus Dexamethasone Implant Followed by Bevacizumab for the Treatment of Macula Edema Associated with Branch Retinal Vein Occlusion

Affiliations
  • 1Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea. ykkim3@gmail.com
  • 2Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 3Moon's Eye clinic, Suwon, Korea.

Abstract

PURPOSE
To compare visual and anatomical outcomes of intravitreal injections of bevacizumab and dexamethasone implant (Ozurdex) treatment for macular edema associated with branch retinal vein occlusion (BRVO).
METHODS
We retrospectively reviewed patients who underwent intravitreal bevacizumab administered monthly on a pro re nata (PRN) basis (26 eyes, IVB group) or an initial 700-µg dexamethasone implant followed by a bevacizumab PRN injection (20 eyes, IVD group) for treatment of macular edema associated with BRVO. We compared best-corrected visual acuity (BCVA) and central macular thickness (CMT). We also measured ellipsoid zone recovery rate and ganglion cell-inner plexiform layer volume within the center 6 mm zone. A linear mixed model analysis was performed to compare serial changes in BCVA and CMT.
RESULTS
Both groups showed significant improvement in BCVA and significant reduction in CMT. However, BCVA in the first month was significantly better in the IVD group (logarithm of the minimum angle of resolution, IVD group 0.21 ± 0.26 vs. IVB group 0.39 ± 0.30, p = 0.038) and the 1-month CMT was thinner in the IVD group (IVD group 270.0 ± 62.0 µm vs. IVB group 338.9 ± 122.6 µm, p = 0.028), and these trends were maintained during the 6-month follow-up. The IVD group showed more rapid macular edema resolution (p = 0.049); however, there were no significant differences in ellipsoid zone recovery rate (p = 0.268) or ganglion cell-inner plexiform layer volume between the two groups (p = 0.459).
CONCLUSIONS
There were no significant differences in final visual or anatomical outcomes between the two groups; however, initial dexamethasone implant injection followed by bevacizumab PRN injection initially showed more rapid improvement in vision and BRVO-associated macular edema resolution compared to intravitreal bevacizumab administered monthly on a PRN basis.

Keyword

Bevacizumab; Dexamethasone; Macular edema; Retinal vein occlusion
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