title: Three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent-onset branch retinal vein occlusion.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Boostan 9 Ave., Pasdaran St, Tehran, 16666, Iran. arramezani@gmail.com
authors.forename: Alireza
authors.initials: A
authors.lastname: Ramezani
authors.forename: Hamed
authors.initials: H
authors.lastname: Esfandiari
authors.forename: Morteza
authors.initials: M
authors.lastname: Entezari
authors.forename: Siamak
authors.initials: S
authors.lastname: Moradian
authors.forename: Masoud
authors.initials: M
authors.lastname: Soheilian
authors.forename: Babak
authors.initials: B
authors.lastname: Dehsarvi
authors.forename: Mehdi
authors.initials: M
authors.lastname: Yaseri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000068258:Bevacizumab; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007429:Intraocular Pressure; D058449:Intravitreal Injections; D008266:Macula Lutea / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012170:Retinal Vein Occlusion / Q000188:drug therapy* / Q000503:physiopathology; D019233:Retreatment; D016037:Single-Blind Method; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D014222:Triamcinolone Acetonide