Comparison of Bevacizumab and Combined Low-dose Bevacizumab and Triamcinolone in Central Retinal Vein Occlusion

Byung Jae Kim; Hyun Woong Kim; Yong Seop Han; Jong Moon Park; In Young Chung

doi:10.3341/jkos.2016.57.3.438

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Kim, Kim, Han, Park, and Chung: Comparison of Bevacizumab and Combined Low-dose Bevacizumab and Triamcinolone in Central Retinal Vein Occlusion

Original Article

J Korean Ophthalmol Soc 2016;57(3):438-444.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.3.438

Comparison of Bevacizumab and Combined Low-dose Bevacizumab and Triamcinolone in Central Retinal Vein Occlusion

Byung Jae Kim, MD¹, Hyun Woong Kim, MD, PhD², Yong Seop Han, MD, PhD^1,³, Jong Moon Park, MD, PhD^1,³, In Young Chung, MD, PhD^1,³

¹Department of Ophthalmology, Gyeongsang National University School of Medicine1, Jinju, Korea

²Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

³Institute of Health Science, Gyeongsang National University, Jinju, Korea

Address reprint requests to In Young Chung, MD, PhD, Department of Ophthalmology, Gyeongsang National University Hospital, #79 Gangnam-ro, Jinju 52727, Korea, Tel: 82-55-750-8170, Fax: 82-55-758-4158, E-mail: in0chung@hanmail.net

Received 17 September 2015 Revised 21 January 2016 Accepted 17 February 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the effects and intraocular pressure (IOP) results of intravitreal injection of bevacizumab alone compared with intravitreal low-dose bevacizumab combined with low-dose triamcinolone injection in patients with central retinal vein occlusion. Methods: In total, 40 eyes of 40 patients diagnosed with central retinal vein occlusion were evaluated. Of these, 20 eyes of 20 patients were injected with intravitreal bevacizumab (1.25 mg/0.05 mL), and 20 eyes of 20 patients were injected with low-dose bevacizumab (0.625 mg/0.025 mL) combined with low-dose triamcinolone (1 mg/0.025 mL). The best corrected visual acuity (BCVA), central macular thickness (CMT), and IOP of treated eyes were measured before injection and at 1 month, 2 months, and 3 months after injection.

Results

In both the intravitreal bevacizumab and the low-dose bevacizumab combined with low-dose triamcinolone groups, CMT decreased significantly at 1 month, 2 months, and 3 months after injection (p < 0.05). In addition, in both groups, neither IOP nor BCVA decreased significantly at 1 month, 2 months, or 3 months after injection (p > 0.05). The BCVA, IOP, and CMT at 1 month, 2 months, and 3 months after injection showed no significant differences between the intravitreal bevacizumab group and the low-dose bevacizumab combined with low-dose triamcinolone group (p > 0.05).

Conclusions

The CMT of both groups decreased significantly, and BCVA of both groups increased significantly in patients with central retinal vein occlusion. Injection of low-dose intravitreal bevacizumab combined with low-dose intravitreal triamcinolone may be useful for the treatment of central retinal vein occlusion.

Keywords: Central retinal vein occlusion, Intravitreal bevacizumab injection, Intravitreal triamcinolone injection

References

1. Glacet-Bernard A, Coscas G, Chabanel A, et al. Prognostic factors for retinal vein occlusion: prospective study of 175 cases. Ophthalmology. 1996; 103:551–60.

2. Lattanzio R, Torres Gimeno A, Battaglia , Parodi M, Bandello F. Retinal vein occlusion: current treatment. Ophthalmologica. 2011; 225:135–43.

3. Mitchell P, Smith W, Chang A. Prevalence and associations of retinal vein occlusion in Australia. The Blue Mountains Eye Study. Arch Ophthalmol. 1996; 114:1243–7.

4. Klein R, Klein BE, Moss SE, Meuer SM. The epidemiology of retinal vein occlusion: the Beaver Dam Eye Study. Trans Am Ophthalmol Soc. 2000; 98:133–41. discussion 141-3.

5. Rogers S, McIntosh RL, Cheung N, et al. The prevalence of retinal vein occlusion: pooled data from population studies from the United States, Europe, Asia, and Australia. Ophthalmology. 2010; 117:313–9.e1.

6. Laouri M, Chen E, Looman M, Gallagher M. The burden of disease of retinal vein occlusion: review of the literature. Eye (Lond). 2011; 25:981–8.

7. Park H, Ohn YH, Shin H. Clinical characteristics and classifications of retinal vein occlusion. J Korean Ophthalmol Soc. 1996; 37:1022–31.

8. Merin S, Ber I, Ivry M. Retinal ischemia (capillary nonperfusion) in diabetic retinopathy of patients with and without systemic hypertension. Ophthalmologica. 1978; 177:76–81.

9. Domalpally A, Blodi BA, Scott IU, et al. The Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study system for evaluation of optical coherence tomograms: SCORE study report 4. Arch Ophthalmol. 2009; 127:1461–7.

10. Scott IU, Ip MS, VanVeldhuisen PC, et al. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular Edema secondary to branch retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 6. Arch Ophthalmol. 2009; 127:1115–28.

11. Kim H, Moon S, Kang J, Yoon H. Intravitreal triamcinolone versus bevacizumab for treatment of macular edema secondary to branch retinal vein occlusion. J Korean Ophthalmol Soc. 2010; 51:1071–6.

12. Antcliff RJ, Spalton DJ, Stanford MR, et al. Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography study. Ophthalmology. 2001; 108:765–72.

13. Young S, Larkin G, Branley M, et al. Safety and efficacy of intra-vitreal triamcinolone for cystoid macular oedema in uveitis. Clin Experiment Ophthalmol. 2001; 29:2–6.

14. Jonas JB, Söfker A. Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema. Am J Ophthalmol. 2001; 132:425–7.

15. Jonas JB, Hayler JK, Panda-Jonas S. Intravitreal injection of crystalline cortisone as adjunctive treatment of proliferative vitreoretinopathy. Br J Ophthalmol. 2000; 84:1064–7.

16. Danis RP, Ciulla TA, Pratt LM, Anliker W. Intravitreal triamcinolone acetonide in exudative age-related macular degeneration. Retina. 2000; 20:244–50.

17. Challa JK, Gillies MC, Penfold PL, et al. Exudative macular degeneration and intravitreal triamcinolone: 18 month follow up. Aust N Z J Ophthalmol. 1998; 26:277–81.

18. Tao Y, Hou J, Jiang YR, et al. Intravitreal bevacizumab vs triamcinolone acetonide for macular oedema due to central retinal vein occlusion. Eye (Lond). 2010; 24:810–5.

19. Fish GE. Intravitreous bevacizumab in the treatment of macular edema from branch retinal vein occlusion and hemisphere retinal vein occlusion (an AOS thesis). Trans Am Ophthalmol Soc. 2008; 106:276–300.

20. Ehrlich R, Ciulla TA, Moss AM, Harris A. Combined treatment of intravitreal bevacizumab and intravitreal triamcinolone in patients with retinal vein occlusion: 6 months of follow-up. Graefes Arch Clin Exp Ophthalmol. 2010; 248:375–80.

21. Choi SW, Kim HW, Yun IH. Intravitreal bevacizumab treatment of macular edema in central retinal vein occlusion. J Korean Ophthalmol Soc. 2010; 51:707–15.

22. Prager F, Michels S, Kriechbaum K, et al. Intravitreal bevacizumab (Avastin) for macular oedema secondary to retinal vein occlusion: 12-month results of a prospective clinical trial. Br J Ophthalmol. 2009; 93:452–6.

23. Beutel J, Ziemssen F, Lüke M, et al. Intravitreal bevacizumab treatment of macular edema in central retinal vein occlusion: one-year results. Int Ophthalmol. 2010; 30:15–22.

24. Fischer S, Renz D, Schaper W, Karliczek GF. In vitro effects of dexamethasone on hypoxia-induced hyperpermeability and expression of vascular endothelial growth factor. Eur J Pharmacol. 2001; 411:231–43.

25. Gregori NZ, Rosenfeld PJ, Puliafito CA, et al. One-year safety and efficacy of intravitreal triamcinolone acetonide for the management of macular edema secondary to central retinal vein occlusion. Retina. 2006; 26:889–95.

26. Ip MS, Kumar KS. Intravitreous triamcinolone acetonide as treat ment for macular edema from central retinal vein occlusion. Arch Ophthalmol. 2002; 120:1217–9.

27. Chang MW, Kim SW, Oh IK, et al. Intravitreal tamcinolone injection with or without bevacizumab for diabetic macular edema. J Korean Ophthalmol Soc. 2008; 49:1269–74.

28. Kim BS, Chung IY, Park JM, et al. Comparison of intravitreal bevacizumab alone injection and intravitreal combination low-dose bevacizumab-triamcinolone injection or diabetic macular edema. J Korean Ophthalmol Soc. 2014; 55:1155–61.

29. Lee K, Jung H, Sohn J. Comparison of injection of intravitreal drugs with standard care in macular edema secondary to branch retinal vein occlusion. Korean J Ophthalmol. 2014; 28:19–25.

Table 1.

Patient demographics and baseline characteristics

Variable	IVB	IVB + IVTA	p-value
Total number of patients (eye)	20 (20)	20 (20)
Mean age (years)	53.6 ± 16.8	55.5 ± 11.9	0.781^*
Sex (male:female)	11:9	10:10	1.000^†
Duration from onset to treatment ± SD (weeks)	14.23 ± 9.5	17.6 ± 14.9	0.241^*
Lens
Phakic	13	12	0.965^†
Pseudophakic	7 (47%)	8 (53%)	0.935^†

Values are presented as mean ± SD unless otherwise indicated.

IVB = intravitreal bevacizumab injection; IVTA = intravitreal triamcinolen injection.

^* Independent t-test;

^† Fisher's exact test.

Table 2.

Visual acuity, CMT, and IOP results in patients with CRVO

	Baseline	3 months FU	p-value
BCVA (log MAR)
IVB Group	1.184 ± 0.704	0.859 ± 0.516	0.004^†
IVB + IVTA Group	1.178 ± 0.632	0.825 ± 0.357	0.004^†
p-value	0.975^*	0.935^*
CMT (μm)
IVB Group	783.82 ± 112.61	624.47 ± 82.58	0.048^†
IVB + IVTA Group	871.74 ± 97.23	687.06 ± 87.35	0.043^†
p-value	0.588^*	0.671^*
IOP (mm Hg)
IVB Group	14.20 ± 3.11	14.75 ± 3.32	0.845^†
IVB + IVTA Group	15.14 ± 7.21	15.59 ± 7.75	0.844^†
p-value	0.872^*	0.824^*

Values are presented as mean ± SD unless otherwise indicated.

CMT = central macular thickness; IOP = intraocular pressure; CRVO = central retinal vein occlusion; FU = follow up; BCVA = best corrected visual acuity; IVB = intravitreal bevacizumab injection; IVTA = intravitreal triamcinolen injection.

^* Independent t-test;

^† p-value compared with baseline, paired t-test.

Table 3.

Comparison of visual acuity between IVB and IVB + IVTA Groups

	IVB Group	IVB + IVTA Group	p-value
BCVA (log MAR)
Baseline	1.184 ± 0.704	1.178 ± 0.632	0.975^*
Post-op 1 month	0.844 ± 0.571 (0.003^†)	0.877 ± 0.471 (0.026^†)	0.942^*
Post-op 2 months	0.807 ± 0.654 (0.003^†)	0.791 ± 0.544 (0.003^†)	0.967^*
Post-op 3 months	0.859 ± 0.516 (0.004^†)	0.825 ± 0.357 (0.004^†)	0.895^*
Mean changes of BCVA
Post-op 1 month	-0.294 ± 0.295	-0.351 ± 0.391	0.667^*
Post-op 2 months	-0.328 ± 0.313	-0.443 ± 0.323	0.384^*
Post-op 3 months	-0.277 ± 0.274	-0.355 ± 0.411	0.597^*

Values are presented as mean ± SD unless otherwise indicated.

IVB = intravitreal bevacizumab injection; IVTA = intravitreal triamcinolen injection; BCVA = best corrected visual acuity; Post-op = postoperative.

^* Independent t-test;

^† p-value compared with baseline, paired t-test.

Table 4.

Comparison of CMT between IVB and IVB + IVTA Groups

	IVB Group (n = 20)	IVB + IVTA Group (n = 20)	p-value
Mean CMT (μm)
Baseline	783.82 ± 112.61	871.74 ± 97.23	0.079^*
Post-op 1 month	348.23 ± 72.57 (0.011^†)	304.21 ± 67.84 (0.009^†)	0.157^*
Post-op 2 months	571.75 ± 92.54 (0.024^†)	491.15 ± 95.51 (0.016^†)	0.081^*
Post-op 3 months	624.47 ± 82.58 (0.048^†)	687.06 ± 87.35 (0.043^†)	0.198^*
Mean changes of CMT
Post-op 1 month	-435.59 ± 84.45	-567.53 ± 79.55	0.082^*
Post-op 2 months	-212.07 ± 62.28	-380.59 ± 67.49	0.114^*
Post-op 3 months	-159.35 ± 57.42	-187.68 ± 97.94	0.132^*

Values are presented as mean ± SD unless otherwise indicated.

CMT = central macular thickness; IVB = intravitreal bevacizumab injection; IVTA = intravitreal triamcinolen injection; Post-op = postoperative.

^* Independent t-test;

^† p-value compared with baseline, paired t-test.

Table 5.

Comparison of IOP between IVB and IVB + IVTA Groups

	IVB Group (n = 20)	IVB + IVTA Group (n = 20)	p-value
Mean IOP (mm Hg)
Baseline	14.20 ± 3.11	15.14 ± 7.21	0.412^*
Post-op 1 month	14.27 ± 3.07 (0.635^†)	17.84 ± 6.47 (0.251^†)	0.092^*
Post-op 2 months	14.15 ± 3.34 (0.597^†)	16.45 ± 6.84 (0.344^†)	0.071^*
Post-op 3 months	14.75 ± 3.32 (0.687^†)	15.59 ± 7.75 (0.592^†)	0.054^*
Mean changes of IOP
Post-op 1 month	1.02 ± 1.75	0.98 ± 5.14
Post-op 2 months	1.06 ± 1.85	2.01 ± 5.54
Post-op 3 months	1.43 ± 1.96	4.55 ± 8.27

Values are presented as mean ± SD unless otherwise indicated.

IOP = intraocular pressure; IVB = intravitreal bevacizumab injection; IVTA = intravitreal triamcinolen injection; Post-op = postoperative.

^* Independent t-test;

^† p-value compared with baseline, paired t-test.

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