Intravitreal Combined Bevacizumab with Dexamethasone for ...

RETINA/ VITREOUS SESSION-I
Intravitreal Combined Bevacizumab with Dexamethasone for
Treatment of Diffuse Macular Oedema in BRVO
Dr. Shroff Rahul Ashok, Dr. Anand Shroff, Dr. Ashok Shroff
(Presenting Author: Dr. Shroff Rahul Ashok)
Branch retinal vein occlusion is a retinal
vascular disorder with concomittent macular
oedema is frequently the cause of vision loss. The
current gold standard is macular grid
photocoagulation, but patients but patients
derive only limited benefit. Treatment for
macular oedema are mainly aimed at reducing
the macular thickness. Corticosteroids inhibit the
expression of VEGF and along with their antiinflammatory
properties may be effective
therapy for macular oedema. The score study
comparing the safety and efficacy to
triamcinolone acetonide showed no difference in
vision between treated group and standard care
group. However the incidence of cataract and
glaucoma due to the use of triamcinolone was
much higher in the treated group. Studies show
that intravitreal Bevacizumab targets the
vascular endothelial growth factor(VEGF) and
can help to reduce the macular oedema.. The
purpose of the study is to show that given in
conjunction with dexamethasone it can prolong
the action of treatment.
Materials and Methods
The inclusion criteria was recent branch retinal
573
vein occlusion with macular oedema involving
the fovea with diffuse macular oedema seen on
fluorescein angiography and a central macular
thickness of >250 micron seen on OCT.
Exclusion criteria was retinal or macular
pathology other than BRVO, advanced cataract,
glaucoma and vitreous haemorrhage.
The primary outcome measure was gain in visual
acuity from baseline and a reduction in central
macular thickness on OCT from baseline.
All patients underwent a BCVA test, IOP check,
slit-lamp examination, fundus examination,
fluorescein angiography and OCT at baseline.
Patients were injected 1.25mg Bevacizumab and
700Ugm Dexamethasone intravitreally.
Patients were called for a followup every 4 mths.
Criteria for reinjection were if there was increase
macular edema compared to earlier visit. BCVA,
IOP check, fundus examination and OCT were
done on each visit. Statistical analyses was done
using paired t test to evaluate significance and
95% confidence interval for mean change.
Results
The mean followup was 12 mths. The mean best

574 AIOC 2010 PROCEEDINGS
corrected visual acuity was 6/24 (95% confidence
interval – 6/18 to 6/36) at baseline and 6/24 (95%
confidence interval – 6/12 to 6/60) at final
followup. Paired t test showed p value = 0.58 .
The mean central macular thickness(CMT) was
370 microns (95% confidence interval –
344microns to 396microns) at baseline and 221
microns (95% confidence interval – 206microns
to 236microns) at final followup. . Paired t test
showed p value = 0.006 for central macular
thickness.
Intravitreal Combined Bevacizumab with
Dexamethasone injection showed no statistically
significant change in vision after treatment.
However there was significant improvement in
the macular oedema seen on OCT. Also there
was no correlation between macular thickness
and visual acuity.