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

Han Song; Hee Jun Song; Ji Ho Yang; Do Gyun Kim

doi:10.3341/jkos.2018.59.9.834

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Song, Song, Yang, and Kim: A Comparison of Three Intravitreal Modalities of Branch Retinal Vein Occlusion Macular Edema

Original Article

Journal of the Korean Ophthalmological Society 2018; 59(9): 834-841.

Published online: 17 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.9.834

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

Han Song, MD, Hee Jun Song, MD, Ji Ho Yang, MD, Do Gyun Kim, MD, PhD

Department of Ophthalmology, Myongji Hospital, Goyang, Korea.

Address reprint requests to Do Gyun Kim, MD, PhD. Department of Ophthalmology, Myongji Hospital, #55 Hwasu-ro 14beon-gil, Deogyang-gu, Goyang 10475, Korea. Tel: 82-31-810-6250, Fax: 82-31-810-0500, Kimdk89@empas.com

Received 17 May 2018 Revised 23 June 2018 Accepted 28 August 2018

The Korean Ophthalmological Society

(open-access):

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

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.

Keywords: Bevacizumab, Branch retinal vein occlusion, Dexamethasone implant, Triamcinolone

Figures and Tables

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).

Table 1

Baseline characteristics of the study patients

Values are presented as mean ± SD unless otherwise indicated.

ME = macular edema; BCVA = best-corrected visual acuity; CMT = central macular thickness; IOP = intra-ocular pressure.

^*Kruskal–Wallis test.

Table 2

Alteration of best-corrected visual acuity (BCVA), central macular thickness (CMT), and intra-ocular pressure (IOP)

Values are presented as mean ± SD unless otherwise indicated.

^*Kruskal–Wallis test; ^†Friedman two way analysis of variance (ANOVA) by rank.

Table 3

Improvement degree of best-corrected visual acuity (BCVA) and central macular thickness (CMT)

ues are presented as mean ± SD unless otherwise indicated.

^*Kruskal–Wallis test.

Table 4

Post-hoc analysis of difference of central macular thickness from the baseline at third month among groups

Values are presented as mean ± SD unless otherwise indicated.

^*Bonferroni's method.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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