title: Intravitreal triamcinolone versus intravitreal bevacizumab in the treatment of exudative retinal detachment secondary to posterior uveal melanoma.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of prompt intravitreal triamcinolone acetonide injection (4 mg/0.1 mL) vs intravitreal bevacizumab injection (1.25 mg/0.05 mL) compared with observation in the management of extensive exudative retinal detachment secondary to posterior uveal melanoma.
  
  
  METHODS
  Retrospective, nonrandomized, interventional case series.
  
  
  METHODS
  setting: Institutional. patients: Ninety-six patients affected by posterior uveal melanoma with large exudative retinal detachment (>10 mm in largest basal diameter) were included. intervention: Patients received intravitreal triamcinolone acetonide (32 eyes) or intravitreal bevacizumab (32 eyes) at plaque removal. Thirty-two patients served as controls (observation group). All groups were matched for age, sex, initial tumor thickness and largest basal diameter, largest exudative retinal detachment basal diameter, tumor location, and Bruch membrane rupture. Patients underwent monthly follow-up examinations in the first 6 months and every 3 months thereafter. Follow-up was longer than 24 months. main outcome measure: Exudative retinal detachment resolution (B-scan ultrasonography), steroid-induced cataract, steroid-induced increased IOP.
  
  
  RESULTS
  Follow-up was 37 ± 7 months. Marked exudative retinal detachment regression was documented in 22 (69%) intravitreal triamcinolone acetonide-treated vs 11 (34%) intravitreal bevacizumab-treated and 9 (28%) untreated eyes (P = .0007 and P = .0001, respectively). No statistical significance was found between intravitreal bevacizumab group vs observation group (P = .45) Steroid-induced cataract was observed in 4 intravitreal triamcinolone acetonide-treated patients (12%). Neither steroid-induced increased IOP nor other short- or long-term side effects were documented.
  
  
  CONCLUSIONS
  Intraoperative intravitreal triamcinolone acetonide injection induces earlier and marked exudative retinal detachment resolution after brachytherapy of posterior uveal melanoma. Risk and benefit should be balanced vs steroid-induced cataract.
authors.affiliation: G.B. Bietti Foundation, IRCCS, Rome, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Parrozzani
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Pilotto
authors.forename: Alessia
authors.initials: A
authors.lastname: Dario
authors.forename: Giacomo
authors.initials: G
authors.lastname: Miglionico
authors.forename: Edoardo
authors.initials: E
authors.lastname: Midena
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000068258:Bevacizumab; D001918:Brachytherapy; D005122:Exudates and Transudates; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D058449:Intravitreal Injections; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008545:Melanoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000532:radiotherapy; D008875:Middle Aged; D012029:Refraction, Ocular / Q000502:physiology; D012163:Retinal Detachment / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D058471:Subretinal Fluid; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014463:Ultrasonography; D014604:Uveal Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000532:radiotherapy; 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; D007457:Iodine Radioisotopes; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D014222:Triamcinolone Acetonide