English

Abstract

PURPOSE: to compare the efficacy of intravitreal bevacizumab and combined bevacizumab and Triamcinolone, in the treatment of macular edema in CRVO. The efficacy is studied by the anatomical and visual improvements. BACKGROUND: macular edema is the most common cause of visual loss in central retinal vein occlusion. Many treatments have been advocated with the recent trend being the usage of intravitreal anti-VEGF agents and steroids. METHODS: 30 eyes of 30 patients (17 male and 13 female) with recent onset non-ischemic CRVO were enrolled in a prospective randomized consecutive comparative study. Group I with 15 eyes were given intravitreal injection of 1.25 mg/0.05 ml of Avastin and group II with 15 eyes were given intravitreal combination of 1.25 mg/0.05 ml Avastin and 2 mg/0.05 ml of Triamcinolone. All eyes were examined at baseline and at six weeks of injection. Changes in best corrected visual acuity (letters of ETDRS chart) and central macular thickness were studied. IOP was also focused on. RESULTS: In group I the BCVA increased from 34.80±7.01 letters to 49.3±5.82 letters with an increase of 14.33±7.40 letters (P=0.0001). The Mean CMT in group I changed from 578.27 ± 115.36μ to 204.00±13.57μ with a decrease of 374.27±107.74μ (P=0.0001). In group II BCVA increased from 30.07±9.38 letters to 47.73±11.59 letters by 17.67±13.60 letters (P=0.001) and mean CMT decreased from 586.27±144.94 μ to 209.40±18.38μ with a change of 376.87±153.32μ (P=0.004). There was no significant difference between these two groups with regards to mean BCVA (P=0.411) and CMT (P=0.958). Three eyes in group I had subconjunctival hemorrhage. In group II two patients had subconjunctival hemorrhage and two patients had rise in IOP which was controlled medically. CONCLUSIONS: Intravitreal injection of bevacizumab alone or combined bevacizumab + triamcinolone had a beneficial effect on visual acuity improvement and central macular thickness reduction, in macular edema associated with central retinal vein occlusion. Our results showed that both are equally efficacious. Multicentre randomized trials with longer followup are needed to evaluate the long term safety and efficacy of this combination treatment.