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Rasha I. Ali, Gibran S. Khurshid; Combined Treatment With Intravitreal Bevacizumab And Intravitreal Triamcinolone Acetate In Patients With Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1254.
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© ARVO (1962-2015); The Authors (2016-present)
To report the six month results of combined treatment with intravitreal bevacizumab and triamcinolone acetate for patients with branch retinal vein occlusion (BRVO).
In this retrospective case series, intravitreal bevacizumab (1.25mg) and intravitreal triamcinolone (2mg) were simultaneously administered to twenty patients with clinically identified BRVO within one to eight weeks of diagnosis. Anterior chamber paracentesis was performed on each patient in between administration of the two intravitreal injections. Patient characteristics reviewed were age, gender, previous ocular interventions, duration of vein occlusion prior to intravitreal administration, and number of intraocular injections. Clinical endpoints included intraocular pressure (IOP as mmHg), visual acuity (VA as logMAR) and central macular thickness (CMT as µm) as measured by Spectralis optical coherence tomography (OCT) at 1, 3, and 6 months post injections. Patients unable to be followed for at least 6 months or who had concomitant ocular pathology (i.e. diabetic retinopathy, glaucoma) were excluded.
The mean age of patients was 61.3 ± 7.6 years. Six patients were female and fourteen were male. Mean duration of BRVO prior to intravitreal injection was 3 weeks ± 1.6. Six out of 20 patients (30%) were re-injected at 3 months. Initial visual acuity was logMAR 1.08 ± 0.35. Mean logMAR VA at 1, 3, and 6 months was 0.55 ± 0.17 (p < 0.001), 0.56 ± 0.21 (p < 0.001), and 0.38 ± 0.1 (p < 0.001). Mean initial central macular thickness was 482 ± 107. Mean CMT at 1, 3, and 6 months was 319 ± 53 (p < 0.001), 344 ± 89 (p < 0.001), and 241 ± 29 (p < 0.001). Intraocular pressure initially was 16.5 ± 3.2. IOP was 21 ± 4.4 at 1 month, 16.3 ± 2.1 at 3 months, and 15.4 ± 1.8 at 6 months.
This study suggests that combined treatment with intravitreal bevacizumab and intravitreal triamcinolone improves structural and visual outcomes in patients with BRVO treated as early as possible. IOP transiently increased 1 month after injection in six patients (30%), but returned to baseline levels by 6 months with one topical beta blocker. No endophthalmitis was observed. Intravitreal bevacizumab and triamcinolone may have a synergistic effect on minimizing the sequela of vision threatening macular edema secondary to branch retinal vein occlusion.
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