J Korean Ophthalmol Soc.  2018 Sep;59(9):834-841. 10.3341/jkos.2018.59.9.834.

A Comparison of Three Intravitreal Modalities of Branch Retinal Vein Occlusion Macular Edema

• Song H
• Song HJ
• Yang JH
• Kim DG

• KMID: 2420331
• DOI: http://doi.org/10.3341/jkos.2018.59.9.834

Abstract

PURPOSE
Short-term results regarding the efficacy of intravitreal bevacizumab, dexamethasone implants, and triamcinolone-bevacizumab in macular edema (ME) secondary to branch retinal vein occlusion (BRVO) were compared.
METHODS
This study included 30 eyes of with BRVO and ME. Patients received the following treatments: 1.25 mg of bevacizumab (group 1, n = 9), 0.7 mg of dexamethasone as an implant (group 2, n = 12), or a combination of 2 mg of triamcinolone acetonide and 1.25 mg of bevacizumab (group 3, n = 9). Measurements of visual acuity and central macular thickness (CMT) with optical coherence tomography were performed at baseline, and at 1 and 3 months injection.
RESULTS
Compared to baseline, the CMT was significantly decreased in all groups by 326.32 ± 149.32, 311.50 ± 58.54, and 282 ± 28.21, respectively, at 1 month and 407 ± 160, 348 ± 108, and 289 ± 66, respectively, at 3 months, but there was no significant difference within each group. Compared to baseline, best-corrected visual acuity (BCVA) was significantly increased in all groups at 1 month and 3 months. Using post hoc analysis, there was no significant difference in the degrees of BCVA gain, but in degrees of CMT reduction, groups 2 and 3 were significantly higher than group 1 at 1 month and only group 3 was significantly higher than group 1 at 3 months (p < 0.017).
CONCLUSIONS
The intravitreal injection of bevacizumab, a dexamethasone implant, or a combination of triamcinolone-bevacizumab could be effectively used in the treatment of ME due to BRVO. For ME, steroid treatment showed a greater reduction percentage, and in the case of the triamcinolone-bevacizumab combination, we could cover the short half-life of bevacizumab and the complications of steroid use. In severe cases of ME, an intravitreal dexamethasone implant or a combination of triamcinolone and bevacizumab can be considered as the first-line therapy.

Keyword

Bevacizumab; Branch retinal vein occlusion; Dexamethasone implant; Triamcinolone

MeSH Terms

Bevacizumab
Dexamethasone
Edema*
Half-Life
Humans
Intravitreal Injections
Macular Edema
Retinal Vein Occlusion*
Retinal Vein*
Retinaldehyde*
Tomography, Optical Coherence
Triamcinolone
Triamcinolone Acetonide
Visual Acuity
Bevacizumab
Dexamethasone
Retinaldehyde
Triamcinolone
Triamcinolone Acetonide

Figure

• 

  Figure 1 Changes of central macular thickness (CMT) after intravitreal injection. Compared with baseline, mean amount of decrease were 155.32 ± 151.12, 190.50 ± 126.51, 289.52 ± 121.83 μm in group 1, group 2, and group 3, respectively at 1 month after injection and group 2 and 3 showed greater CMT change than group 1 in post-hoc analysis (p < 0.017). Mean amount of decrease were 74.10 ± 138.61, 153.14 ± 85.62, 282.21 ± 145.90 μm in group 1, group 2, and group 3, respectively at 3 months after injection and only group 3 showed greater CMT change than group 1 in post-hoc analysis (p < 0.017).

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