IJCRR - 5(12), June, 2013
COMPARISON OF POSTERIOR SUB-TENON TRIAMCINOLONE WITH INTRAVITREAL BEVACIZUMAB FOR MACULAR EDEMA IN NON-ISCHEMIC RETINAL VEIN OCCLUSIONS
Author: Murali Mohan Gurram
Purpose: to compare the efficacy of posterior sub-tenon triamcinolone (PSTT) with intravitreal bevacizumab, when used as the primary treatment for macular edema associated with retinal vein occlusions. The efficacy is studied in improvement of visual acuity and reduction in macular edema. Background: Macular edema is the commonest cause of visual loss in retinal vein occlusions. Many treatments have been advocated including LASER, PSTT etc. with the recent trend being the usage of intravitreal anti VEGF agents and steroids. Methods: In a retrospective comparative case series, the records of patients who received PSTT (group I) and those who received Intravitreal bevacizumab (Group II) for macular edema associated with retinal vein occlusions, between march 2010 and September 2012 were analyzed. Group I had 24 eyes of 24 patients (13 male and 11 female) and group II had 26 eyes of 26 patients (13 male and 13 female). Group I had received Posterior Sub-Tenon injection of Preservative free Triamcinolone Acetonide (40 mg/1 ml) and group II had received intravitreal injection of 1.25 mg/0.05 ml avastin. Changes after four weeks of treatment, in best corrected visual acuity (letters of ETDRS chart) and central macular thickness (time domain OCT measurements) were studied. IOP was also focused on. Results: In group I the BCVA increased from 30.08±10.16 letters to 40.21 ±8.93 letters with an increase of 10.13 ±8.20 letters (P=<0.001). The Mean CMT in group I changed from 575.08 ± 131.55 μ to 305.54 ± 157.10 μ with a decrease of 269.54 ± 149.78 μ (P=<0.001). In group II BCVA increased from 33.81 ± 7.60 letters to 54.89 ± 8.96 letters by 21.08 ± 11.98 letters (P=0.001) and mean CMT decreased from 570.35 ± 115.01 μ to 206.58 ± 22.18 with a change of 363.77 ± 104.71 μ (P=0.004). Group II had better effect both on BCVA and CMT which was statistically significant (P value for BCVA <0.001 and for CMT 0.013). No major complications were noted in either group. Conclusions: Both PSTT and IVB are effective in decreasing the CMT and increasing the BCVA in cases of macular edema due to Non-ischemic Retinal vein occlusions. IVB is better option, when compared to PSTT as shown by significant P value. But in view of the extraocular nature and less complications reported with PSTT, it can be tried as first line of treatment before contemplating IVB. Multicenter randomized trials with longer follow-up are needed to evaluate the long term safety and efficacy of these treatments.
Keywords: avastin, bevacizumab, intravitreal injection, posterior subtenon injection, Retinal vein occlusion, triamcinolone Acetonide
Murali Mohan Gurram. COMPARISON OF POSTERIOR SUB-TENON TRIAMCINOLONE WITH INTRAVITREAL BEVACIZUMAB FOR MACULAR EDEMA IN NON-ISCHEMIC RETINAL VEIN OCCLUSIONS International Journal of Current Research and Review. 5(12), June, 61-71
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