Skip to main content

Advertisement

SpringerLink
Log in

Three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent-onset branch retinal vein occlusion

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the effects of repeated intravitreal injections of bevacizumab (IVB) versus triamcinolone acetonide (IVT) in the treatment of acute branch retinal vein occlusion (BRVO).

Methods

In this randomized clinical trial, 86 eyes with recent-onset (less than 12 weeks) BRVO were included. Participants were randomly assigned to two treatment groups: (1) IVB group (43 eyes), patients who received three monthly injections of 1.25 mg of IVB, and (2) IVT group (43 eyes), patients who received two injections of 2 mg IVT 2 months apart. Patients were examined at 1, 2, 3, 4, and 6 months after enrollment. Main outcome measure was change in best-corrected visual acuity (BCVA) at 6 months. Secondary outcome measures were central macular thickness (CMT) and intraocular pressure (IOP) changes at month 6.

Results

Mean BCVA improved significantly up to 6 months in both groups from 0.68 ± 0.25 to 0.31 ± 0.21 logMAR (logarithm of minimum angle of resolution) in the IVB group, and from 0.67 ± 0.29 to 0.46 ± 0.31 logMAR in the IVT group (P < 0.001 for both). However, between-group differences reach to a significant level at months 4 (P = 0.013) and 6 (P < 0.001) in favor of the IVB group. In terms of CMT reduction, similarly, both groups showed a significant decrease at months 3 and 6, and the differences between the groups were statistically significant (P = 0.031) at final visit. Dividing the cases into ischemic and non-ischemic types, a significant difference was noted only in the ischemic cases regarding BCVA improvement and CMT reduction in favor of the IVB group. Mean IOP rise was significantly higher in the IVT group at all visits.

Conclusions

Both 3-times-monthly IVB injections and 2-times IVT injections with a 2-month interval could be effective for improving BCVA and CMT in cases with recent-onset BRVO up to 6 months. However, considering the better visual and anatomic outcomes after IVB injections and the potential complications of IVT injections, we would recommend prescheduled repeated IVB injections for such cases. The favorable responses were more pronounced in the ischemic types of BRVO in this trial; nevertheless, this should be confirmed in larger studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Branch Vein Occlusion Study Group (1984) Argon laser photocoagulation for macular edema in branch vein occlusion. Am J Ophthalmol 98: 271–282

    Google Scholar 

  2. Mitchell P, Smith W, Chang A (1996) Prevalence and associations of retinal vein occlusion in Australia. The Blue Mountains Eye Study. Arch Ophthalmol 114:1243–1247

    Article  PubMed  CAS  Google Scholar 

  3. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL (1984) The Wisconsin epidemiologic study of diabetic retinopathy. IV. Diabetic macular edema. Ophthalmology 91:1464–1474

    PubMed  CAS  Google Scholar 

  4. Finkelstein D (1992) Ischemic macular edema. Recognition and favorable natural history in branch vein occlusion. Arch Ophthalmol 110:1427–1434

    Article  PubMed  CAS  Google Scholar 

  5. McIntosh RL, Mohamed Q, Saw SM, Wong TY (2007) Interventions for branch retinal vein occlusion: an evidence-based systematic review. Ophthalmology 114:835–854

    Article  PubMed  Google Scholar 

  6. Oh JY, Seo JH, Ahn JK, Heo JW, Chung H (2007) Early versus late intravitreal triamcinolone acetonide for macular edema associated with branch retinal vein occlusion. Korean J Ophthalmol 21:18–20

    Article  PubMed  Google Scholar 

  7. Lin JM, Chiu YT, Hung PT, Tsai YY (2007) Early treatment of severe cystoid macular edema in central retinal vein occlusion with posterior sub-tenon triamcinolone acetonide. Retina 27:180–189

    Article  PubMed  Google Scholar 

  8. Aiello LP, Avery RL, Arrigg PG, Keyt BA, Jampel HD, Shah ST, Pasquale LR, Thieme H, Iwamoto MA, Park JE (1994) Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 331:1480–1487

    Article  PubMed  CAS  Google Scholar 

  9. Rosenfeld PJ, Fung AE, Puliafito CA (2005) Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for macular edema from central retinal vein occlusion. Ophthalmic Surg Lasers Imaging 36:336–339

    PubMed  Google Scholar 

  10. Iturralde D, Spaide RF, Meyerle CB, Klancnik JM, Yannuzzi LA, Fisher YL, Sorenson J, Slakter JS, Freund KB, Cooney M, Fine HF (2006) Intravitreal bevacizumab (Avastin) treatment of macular edema in central retinal vein occlusion: a short-term study. Retina 26:279–284

    Article  PubMed  Google Scholar 

  11. Kreutzer TC, Alge CS, Wolf AH, Kook D, Burger J, Strauss R, Kunze C, Haritoglou C, Kampik A, Priglinger S (2008) Intravitreal bevacizumab for the treatment of macular oedema secondary to branch retinal vein occlusion. Br J Ophthalmol 92:351–355

    Article  PubMed  CAS  Google Scholar 

  12. Gunduz K, Bakri SJ (2008) Intravitreal bevacizumab for macular oedema secondary to branch retinal vein occlusion. Eye 22:1168–1171

    Article  PubMed  CAS  Google Scholar 

  13. Wu L, Arevalo JF, Roca JA, Maia M, Berrocal MH, Rodriguez FJ, Evans T, Costa RA, Cardillo J (2008) Comparison of two doses of intravitreal bevacizumab (Avastin) for treatment of macular edema secondary to branch retinal vein occlusion: results from the Pan-American Collaborative Retina Study Group at 6 months of follow-up. Retina 28:212–219

    Article  PubMed  CAS  Google Scholar 

  14. Wu L, Arevalo JF, Berrocal MH, Maia M, Roca JA, Morales-Canton V, Alezzandrini AA, Diaz-Llopis MJ (2009) Comparison of two doses of intravitreal bevacizumab as primary treatment for macular edema secondary to branch retinal vein occlusions: results of the Pan American Collaborative Retina Study Group at 24 months. Retina 29:1396–1403

    Article  PubMed  Google Scholar 

  15. Wilson CA, Berkowitz BA, Sato Y, Ando N, Handa JT, De Juan E Jr (1992) Treatment with intravitreal steroid reduces blood–retinal barrier breakdown due to retinal photocoagulation. Arch Ophthalmol 110:1155–1159

    Article  PubMed  CAS  Google Scholar 

  16. Penfold PL, Wong JG, Gyory J, Billson FA (2001) Effects of triamcinolone acetonide on microglial morphology and quantitative expression of MHC-II in exudative age-related macular degeneration. Clin Experiment Ophthalmol 29:188–192

    Article  PubMed  CAS  Google Scholar 

  17. Jonas JB, Akkoyun I, Kamppeter B, Kreissig I, Degenring RF (2005) Branch retinal vein occlusion treated by intravitreal triamcinolone acetonide. Eye 19:65–71

    Article  PubMed  CAS  Google Scholar 

  18. Avitabile T, Longo A, Reibaldi A (2005) Intravitreal triamcinolone compared with macular laser grid photocoagulation for the treatment of cystoid macular edema. Am J Ophthalmol 140:695–702

    Article  PubMed  CAS  Google Scholar 

  19. Scott IU, Ip MS, VanVeldhuisen PC, Oden NL, Blodi BA, Fisher M, Chan CK, Gonzalez VH, Singerman LJ, Tolentino M (2009) 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 127:1115–1128

    Article  PubMed  Google Scholar 

  20. Chen CH, Chen YH, Wu PC, Chen YJ, Lee JJ, Liu YC, Kuo HK (2010) Treatment of branch retinal vein occlusion induced macular edema in treatment-naive cases with a single intravitreal triamcinolone or bevacizumab injection. Chang Gung Med J 33:424–435

    PubMed  Google Scholar 

  21. Lim JW (2011) Intravitreal bevacizumab and cytokine levels in major and macular branch retinal vein occlusion. Ophthalmologica 225:150–154

    Article  PubMed  CAS  Google Scholar 

  22. Moradian S, Faghihi H, Sadeghi B, Piri N, Ahmadieh H, Soheilian M, Dehghan MH, Azarmina M, Esfahani MR (2011) Intravitreal bevacizumab vs. sham treatment in acute branch retinal vein occlusion with macular edema: results at 3 months (Report 1). Graefes Arch Clin Exp Ophthalmol 249:193–200

    Article  PubMed  CAS  Google Scholar 

  23. Kondo M, Kondo N, Ito Y, Kachi S, Kikuchi M, Yasuma TR, Ota I, Kensaku M, Terasaki H (2009) Intravitreal injection of bevacizumab for macular edema secondary to branch retinal vein occlusion:results after 12 months and multiple regression analysis. Retina 29:1242–1248

    Article  PubMed  Google Scholar 

  24. Rensch F, Jonas JB, Spandau UH (2009) Early intravitreal bevacizumab for non-ischaemic branch retinal vein occlusion. Ophthalmologica 223:124–127

    Article  PubMed  CAS  Google Scholar 

  25. Rouvas A, Petrou P, Ntouraki A, Douvali M, Ladas I, Vergados I (2010) Intravitreal ranibizumab (Lucentis) for branch retinal vein occlusion-induced macular edema: nine-month results of a prospective study. Retina 30:893–902

    Article  PubMed  Google Scholar 

  26. Campochiaro PA, Heier JS, Feiner L, Gray S, Saroj N, Rundle AC, Murahashi WY, Rubio RG (2010) Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology 117(1102–1112):e1101

    Google Scholar 

  27. Wroblewski JJ, Wells JA 3rd, Gonzales CR (2010) Pegaptanib sodium for macular edema secondary to branch retinal vein occlusion. Am J Ophthalmol 149:147–154

    Article  PubMed  CAS  Google Scholar 

  28. Gillies MC (2006) What we don't know about avastin might hurt us. Arch Ophthalmol 124:1478–1479

    Article  PubMed  Google Scholar 

  29. Oosthuyse B, Moons L, Storkebaum E, Beck H, Nuyens D, Brusselmans K, Van Dorpe J, Hellings P, Gorselink M, Heymans S, Theilmeier G, Dewerchin M, Laudenbach V, Vermylen P, Raat H, Acker T, Vleminckx V, Van Den Bosch L, Cashman N, Fujisawa H, Drost MR, Sciot R, Bruyninckx F, Hicklin DJ, Ince C, Gressens P, Lupu F, Plate KH, Robberecht W, Herbert JM, Collen D, Carmeliet P (2001) Deletion of the hypoxia-response element in the vascular endothelial growth factor promoter causes motor neuron degeneration. Nat Genet 28:131–138

    Article  PubMed  CAS  Google Scholar 

  30. Michaelides M, Fraser-Bell S, Hamilton R, Kaines A, Egan C, Bunce C, Peto T, Hykin P (2010) Macular perfusion determined by fundus fluorescein angiography at the 4-month time point in a prospective randomized trial of intravitreal bevacizumab or laser therapy in the management of diabetic macular edema (Bolt Study): Report 1. Retina 30:781–786

    Article  PubMed  Google Scholar 

  31. Cakir M, Dogan M, Bayraktar Z, Bayraktar S, Acar N, Altan T, Kapran Z, Yilmaz OF (2008) Efficacy of intravitreal triamcinolone for the treatment of macular edema secondary to branch retinal vein occlusion in eyes with or without grid laser photocoagulation. Retina 28:465–472

    Article  PubMed  Google Scholar 

  32. Pathai S (2007) Intravitreal triamcinolone acetonide for treatment of persistent macular oedema in branch retinal vein occlusion. Eye 21:255–256

    Article  PubMed  CAS  Google Scholar 

  33. Lubczynska A, Kociecki J (2007) Inhtravitreal triamcinolone acetonide injections in the treatment of cystoid macular edema due to the central or branch retinal vein occlusion. Klin Oczna 109:169–172

    PubMed  Google Scholar 

  34. Prasad AG, Shah GK (2006) Intravitreal triamcinolone for ischemic branch retinal vein occlusion with serous retinal detachment. Retina 26:234–236

    Article  PubMed  Google Scholar 

  35. Ozkiris A, Evereklioglu C, Erkilic K, Dogan H (2006) Intravitreal triamcinolone acetonide for treatment of persistent macular oedema in branch retinal vein occlusion. Eye 20:13–17

    Article  PubMed  CAS  Google Scholar 

  36. Chen SD, Sundaram V, Lochhead J, Patel CK (2006) Intravitreal triamcinolone for the treatment of ischemic macular edema associated with branch retinal vein occlusion. Am J Ophthalmol 141:876–883

    Article  PubMed  CAS  Google Scholar 

  37. Bearelly S, Cooney MJ, Stinnett S, Fekrat S (2006) Intravitreal triamcinolone for cystoid macular edema related to branch retinal vein occlusion. Ann Ophthalmol (Skokie) 38:317–320

    Article  CAS  Google Scholar 

  38. Tsujikawa A, Fujihara M, Iwawaki T, Yamamoto K, Kurimoto Y (2005) Triamcinolone acetonide with vitrectomy for treatment of macular edema associated with branch retinal vein occlusion. Retina 25:861–867

    Article  PubMed  Google Scholar 

  39. Martidis A, Duker JS, Greenberg PB, Rogers AH, Puliafito CA, Reichel E, Baumal C (2002) Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology 109:920–927

    Article  PubMed  Google Scholar 

  40. Beer PM, Bakri SJ, Singh RJ, Liu W, Peters GB 3rd, Miller M (2003) Intraocular concentration and pharmacokinetics of triamcinolone acetonide after a single intravitreal injection. Ophthalmology 110:681–686

    Article  PubMed  Google Scholar 

  41. Hara S, Sakuraba T, Kataoka H, Yanagihashi S, Saitou K, Noda Y (2010) Effect of repeated intravitreal bevacizumab injections for secondary macular edema of branch retinal vein occlusion. Nippon Ganka Gakkai Zasshi 114:1013–1018

    PubMed  Google Scholar 

  42. Rabena MD, Pieramici DJ, Castellarin AA, Nasir MA, Avery RL (2007) Intravitreal bevacizumab (Avastin) in the treatment of macular edema secondary to branch retinal vein occlusion. Retina 27:419–425

    Article  PubMed  Google Scholar 

  43. Stahl A, Agostini H, Hansen LL, Feltgen N (2007) Bevacizumab in retinal vein occlusion-results of a prospective case series. Graefes Arch Clin Exp Ophthalmol 245:1429–1436

    Article  PubMed  CAS  Google Scholar 

  44. Kim H, Csaky KG, Gravlin L, Yuan P, Lutz RJ, Bungay PM, Tansey G, F DEM, Potti GK, Grimes G, Robinson MR (2006) Safety and pharmacokinetics of a preservative-free triamcinolone acetonide formulation for intravitreal administration. Retina 26: 523–530

    Google Scholar 

  45. Krohne TU, Eter N, Holz FG, Meyer CH (2008) Intraocular pharmacokinetics of bevacizumab after a single intravitreal injection in humans. Am J Ophthalmol 146:508–512

    Article  PubMed  CAS  Google Scholar 

  46. Miyake T, Sawada O, Kakinoki M, Sawada T, Kawamura H, Ogasawara K, Ohji M (2010) Pharmacokinetics of bevacizumab and its effect on vascular endothelial growth factor after intravitreal injection of bevacizumab in macaque eyes. Invest Ophthalmol Vis Sci 51:1606–1608

    Article  PubMed  Google Scholar 

  47. Jonas JB (2005) Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases. Acta Ophthalmol Scand 83:645–663

    Article  PubMed  Google Scholar 

  48. Byun YJ, Roh MI, Lee SC, Koh HJ (2010) Intravitreal triamcinolone acetonide versus bevacizumab therapy for macular edema associated with branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 248:963–971

    Article  PubMed  CAS  Google Scholar 

  49. Ramezani A, Entezari M, Moradian S, Tabatabaei H, Kadkhodaei S (2006) Intravitreal triamcinolone for acute central retinal vein occlusion; a randomized clinical trial. Graefes Arch Clin Exp Ophthalmol 244:1601–1606

    Article  PubMed  CAS  Google Scholar 

  50. Jaissle GB, Szurman P, Feltgen N, Spitzer B, Pielen A, Rehak M, Spital G, Heimann H, Meyer CH (2011) Predictive factors for functional improvement after intravitreal bevacizumab therapy for macular edema due to branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 249:183–192

    Article  PubMed  CAS  Google Scholar 

  51. Cheng KC, Wu WC (2006) Intravitreal triamcinolone acetonide for patients with macular edema due to branch retinal vein occlusion. Kaohsiung J Med Sci 22:321–330

    Article  PubMed  CAS  Google Scholar 

  52. Hou J, Tao Y, Jiang YR, Li XX, Gao L (2009) Intravitreal bevacizumab versus triamcinolone acetonide for macular edema due to branch retinal vein occlusion: a matched study. Chin Med J (Engl) 122:2695–2699

    CAS  Google Scholar 

  53. Guthoff R, Meigen T, Hennemann K, Schrader W (2010) Comparison of bevacizumab and triamcinolone for treatment of macular edema secondary to branch retinal vein occlusion in a pair-matched analysis. Ophthalmologica 224:319–324

    Article  PubMed  CAS  Google Scholar 

  54. Kim JY, Park SP (2009) Comparison between intravitreal bevacizumab and triamcinolone for macular edema secondary to branch retinal vein occlusion. Korean J Ophthalmol 23:259–265

    Article  PubMed  CAS  Google Scholar 

  55. Cheng KC, Wu WC, Chen KJ (2009) Intravitreal triamcinolone acetonide vs bevacizumab for treatment of macular oedema secondary to branch retinal vein occlusion. Eye 23:2023–2033

    Article  PubMed  CAS  Google Scholar 

  56. Cekic O, Cakir M, Yazici AT, Alagoz N, Bozkurt E, Faruk Yilmaz O (2010) A comparison of three different intravitreal treatment modalities of macular edema due to branch retinal vein occlusion. Curr Eye Res 35:925–929

    Article  PubMed  CAS  Google Scholar 

  57. Chung EJ, Hong YT, Lee SC, Kwon OW, Koh HJ (2008) Prognostic factors for visual outcome after intravitreal bevacizumab for macular edema due to branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 246:1241–1247

    Article  PubMed  CAS  Google Scholar 

  58. Jonas J, Heatley G, Spaide R, Varma R (2005) Intravitreal triamcinolone acetonide and secondary ocular hypertension. J Glaucoma 14:168–171

    Article  PubMed  Google Scholar 

  59. Cekic O, Chang S, Tseng JJ, Akar Y, Barile GR, Schiff WM (2005) Cataract progression after intravitreal triamcinolone injection. Am J Ophthalmol 139:993–998

    Article  PubMed  Google Scholar 

  60. Greenberg PB, Martidis A, Rogers AH, Duker JS, Reichel E (2002) Intravitreal triamcinolone acetonide for macular oedema due to central retinal vein occlusion. Br J Ophthalmol 86:247–248

    Article  PubMed  Google Scholar 

  61. Roth DB, Chieh J, Spirn MJ, Green SN, Yarian DL, Chaudhry NA (2003) Noninfectious endophthalmitis associated with intravitreal triamcinolone injection. Arch Ophthalmol 121:1279–1282

    Article  PubMed  Google Scholar 

  62. Sutter FK, Gillies MC (2003) Pseudo-endophthalmitis after intravitreal injection of triamcinolone. Br J Ophthalmol 87:972–974

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

None of the authors has financial interest in the materials mentioned in this study.

Author information

Authors and Affiliations

  1. Ophthalmic Research Center, Department of Ophthalmology, Labbafinejad and Imam Hossein Medical Centers, Shahid Beheshti University of Medical Sciences, Boostan 9 Ave., Pasdaran St, Tehran, 16666, Iran

    Alireza Ramezani, Hamed Esfandiari, Morteza Entezari, Siamak Moradian, Masoud Soheilian, Babak Dehsarvi & Mehdi Yaseri

  2. Department of Biostatistics and Epidemiology, Tehran University of Medical Sciences, Tehran, Iran

    Mehdi Yaseri

Authors
  1. Alireza Ramezani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hamed Esfandiari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Morteza Entezari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Siamak Moradian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masoud Soheilian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Babak Dehsarvi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mehdi Yaseri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alireza Ramezani.

Additional information

This study was presented as a poster at the 2010 joint meeting of the American Academy of Ophthalmology and MEACO, Chicago, October 16–19.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ramezani, A., Esfandiari, H., Entezari, M. et al. Three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent-onset branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 250, 1149–1160 (2012). https://doi.org/10.1007/s00417-012-1941-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-012-1941-8

Keywords

Search

Navigation