Combined dexamethasone intravitreal implant (Ozurdex) and macular grid laser versus combined intravitreal bevacizumab and macular grid laser in branch retinal vein occlusion with macular edema

• Main Author: Abdelrahman G Salman
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2015-01-01
• Series: Journal of the Egyptian Ophthalmological Society
• Subjects: Bevacizumab; branch retinal vein occlusion; macular edema; Ozurdex
• Online Access: http://www.jeos.eg.net/article.asp?issn=2090-0686;year=2015;volume=108;issue=4;spage=190;epage=197;aulast=Salman

Purpose The aim of the study was to test a combination of dexamethasone intravitreal implant with macular grid laser versus combined intravitreal bevacizumab (IVB) and macular grid laser for macular edema (ME) in patients with branch retinal vein occlusion (BRVO). Design This study was designed as a prospective, randomized, interventional case series. Patients and methods Sixty eyes with ME secondary to BRVO with central retinal thickness (CRT) more than 400 μm were randomized into three groups: in group 1, 20 eyes underwent an Ozurdex intravitreal implant 0.7 mg at baseline, followed after 1 month with modified grid laser; in group 2, 20 eyes received IVB 1.25 mg/0.05 ml followed after 1 month with modified grid laser; and in group 3, 20 eyes were subjected to only modified grid laser and served as the control group. Patients were followed up monthly for 12 months and retreated with Ozurdex implant in group 1 or IVB in group 2 and group 3 whenever there was recurrence of ME on optical coherence tomography and fundus fluorescein angiography or a decrease in best-corrected visual acuity (BCVA). Recurrence was defined as a decrease in BCVA by 0.3 logMAR or as an increase in CMT by more than 50 μm compared with that in the previous examination. Results Baseline data showed no statistically significant difference between the three groups. In group 1 BCVA and CRT improved significantly at 12 months, to 0.18 ± 0.29 logMAR and 224 ± 51 μm, respectively. In group 2, BCVA improved significantly to 0.38 ± 0.17 logMAR and mean CRT reduced significantly to 258 ± 67 μm. In the control group BCVA at 12 months was 0.40 ± 0.24 and CMT was 362 ± 69 μm. At 12 months two eyes (10%) in group 1, 12 eyes (60%) in group 2, and 14 eyes (70%) in group 3 were retreated. Conclusion The synergistic effect of combined IVB and modified grid laser is comparable to combined DEX implant and modified macular grid laser in the treatment of BRVO with ME with fewer complications but more frequent injections.