Intravitreal injection of bevacizumab alone or with triamcinolone acetonide for treatment of macular edema caused by central retinal vein occlusion

Abstract

Aim: To compare the efficacy and safety of intravitreal bevacizumab alone versus bevacizumab combined with triamcinolone acetonide in eyes with macular edema caused by central retinal vein occlusion (CRVO) in Chinese patients.

Methods: Seventy-five eyes of 75 patients were enrolled in this prospective, randomized, consecutive study. Thirty-six patients in group 1 were treated with an intravitreal injection of bevacizumab (1.25mg/0.05mL), and 39 patients in group 2 were treated with intravitreal bevacizumab (1.25mg/0.05mL) combined with triamcinolone acetonide (2mg/0.05mL). The main outcomes of the mean best corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP) were measured.

Results: In group 1, the mean BCVA improved from 37.78±6.14 (baseline) to 48.06±3.86, 46.48±4.77 and 44.18±5.78 at four, six and twelve weeks post-injection, respectively (P<0.01, P=0.03, P=0.04). In group 2, the mean BCVA improved from 35.92±6.20 (baseline) to 50.69±4.22, 48.76±5.59 and 45.70±6.56 at the same time points (P<0.01 each). However, there was no significant differences in the mean BCVA (F=0.043, P=0.836) and CRT (F=0.374, P=0.544) between these two groups. During the follow-up, five patients in group 1 and six patients in group 2 with high IOP were controlled with anti-glaucoma drugs.

Conclusion: Intravitreal injection of bevacizumab alone or combined with triamcinolone acetonide has a short beneficial effect in Chinese patients with macular edema caused by CRVO, but there is no significant difference between the two groups.

Keywords: bevacizumab; central retinal vein occlusion; macular edema; triamcinolone acetonide.

Figure 1. Boxplot showing the change in BCVA (values are means with standard errors), between two groups, after intravitreal injection of bevacizumab, at baseling and at 4, 6, 12 weeks

Figure 2. Boxplot showing the change in change in CRT (values are means with standard errors), between two groups, after intravitreal injection of bevacizumab, at baseline and at 4, 6, 12 weeks

Figure 3. A: A 64-year old patient with cystoid edema macular secondary to central retinal vein occlusion in the right eye. The patient received a single injection of bevacizumab. Prior to injection, the CRT was 576μm, BCVA was 36 letters; B: After the injection, at 4 weeks CRT was 198μm, VA was 50 letters; C: At 6 weeks CRT was 209μm, VA was 48 letters; D: At 12 weeks CRT was 226μm, VA was 45 letters; E: The fundus photo in the baseline, there are many retinal exudates, hemorrhages in the retina.

Figure 4. A 58-year old patient with cystoid edema macular secondary to central retinal vein occlusion in the left eye. The patient received a single injection of bevacizumab combined with triamcinolone acetonide. Prior to injection, the CRT was 680μm, BCVA was 27 letters; B: After the injection, at 4 weeks CRT was 210 μm, VA was 42 letters; C: At 6 weeks CRT was 209μm, VA was 43 letters; D: At 12 weeks CRT was 237μm, VA was 40 letters; E: The fundus photo in the baseline, there are many retinal exudates, hemorrhages in the retina