Comparison of intravitreal injection of bevacizumab and triamcinolone acetonide in the treatment of uveitic macular edema

ABSTRACT

Cystoid Macular Edema [CME] is one of the most common and sight threatening complications of uveitis. Intravitreal injection of corticosteroids and anti-VEGF antibody are two routine options for treatment. To compare the effects of intravitreal injections of Bevacizumab and Triamcinolone Acetonide for the treatment of persistent macular edema in non-infectious uveitis. In a randomized clinical trial, sixty eyes of 55 patients were enrolled in the study. Patients were divided into two groups with randomized digits table. 29 eyes received 4 mg of intravitreal triamcinolone acetonide, and 31 eyes received 1.25 mg of intravitreal bevacizumab. Two main outcome measures were changes in visual acuity, measured with logarithm of minimal angle of resolution, and central macular thickness, measured with optical coherence tomography. The mean follow-up was 25.3 weeks. The best visual acuities were achieved 6 months after injection in both groups. Improvement in visual acuity at 6 months was achieved in 28/29 [96%] of eyes in Triamcinolone group and in 26/31 [83%] eyes in Bevacizumab group [p=0.196]. None of the eyes showed worsening of visual acuity after 6 months. Mean of central macular thickness in the pre-injection time for intravitreal triamcinolone acetonide [IVTA] group was 295.62 micro, and 309.87 micro in intravitreal bevacizumab [IVB] group, which were decreased after six months to 199.27 micro and 221.06 micro, respectively [p<0.001]. This study shows that IVT and IVB are both effective in improving vision in uveitic CME. Although effects of triamcinolone on Central Macular Thickness [CMT] are more apparent, this superiority is not seen on Best Corrected Visual Acuity [BCVA]