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Wolfgang J. Mayer, Armin Wolf, Lukas Reznicek, Daniel Kook, Anselm Kampik, Michael Ulbig, Christos Haritoglou; A Comparison of Intravitreal Bevacizumab Up-load Followed by a dexamethasone-implant versus dexamethasone-implant Mono Therapy for Retinal Vein Occlusion with Macular Edema. Invest. Ophthalmol. Vis. Sci. 2012;53(14):915.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the efficacy and safety of three intavitreal bevazicumab up-load injections followed by a dexamethasone implant versus a dexamethasone implant mono therapy in eyes with macular edema due to retinal vascular occlusion.
We included 64 eyes of 64 patients in this prospective, consecutive, non-randomized case-series. Group 1 consisted of 38 patients (22 patients with central retinal vein occlusion (CRVO), 16 with branch retinal vein occlusion (BRVO), who were treated using a dexamethasone-implant alone, and group 2 including 26 patients (14 CRVO, 12 BRVO) who were treated with three consecutive intravitreal bevacizumab injections in four weeks intervals followed by a dexamethasone-implant. In case of recurrences, both cohorts received dexamethasone implants during follow-up. Preoperatively, and then in monthly intervals BCVA (ETDRS), central retinal thickness, intraocular pressure, and wide-angle fundus photo documentation were performed. The primary clinical endpoint was BCVA at six months after initiation of therapy. Secondary endpoints were central retinal thickness and safety of the therapy applied.
In group 1, an increase in BCVA (± one standard deviation) of 2.5 (± 1.6) letters in the CRVO and of 13.0 (± 3.2) letters in the BRVO patients was seen after six months. In group 2, an increase of BCVA (± one standard deviation) of 5.9 (± 0.4) letters was seen in CRVO patients versus 3.8 (± 2.4) letters in BRVO patients after 6 months, this was not significant. When comparing the two treatment groups with respect to the type of vein occlusion, there was a significant difference only for BRVO patients in favour for the dexamethasone-implant mono therapy (BRVO patients in group 1) (p = 0.005). The central retinal thickness showed a significant reduction after 6 months only in patients of group 1, both for CRVO (p = 0.01) and BRVO (p = 0.003). In group 1, the first recurrence occurred after 3.8 months (mean) in CRVO patients and 3.5 months in BRVO patients, versus 3.2 months and 3.7 months in CRVO and BRVO patients in group 2. In group 1, 36.4% of patients with CRVO and 25% of patients with BRVO showed an increase of intraocular pressure after treatment. In group 2, an increase was seen in 14.3% of patients with CRVO and 16.7% of patients with BRVO.
In CRVO, there was no difference between the two treatment strategies investigated. However, in BRVO dexamethasone implant mono therapy was associated with better functional outcome. Nevertheless, especially the safety issues such as elevation of intraocular pressure need to be addressed in a longer period of review.
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