Three Intravitreal Bevacizumab versus Two Intravitreal Triamcinolone Injections in Recent Onset Branch Retinal Vein Occlusion

To compare repeated intravitreal injections of bevacizumab (IVB) with triamcinolone acetonide (IVT) for treatment of acute branch retinal vein occlusion (BRVO). This randomized clinical trial included, 86 eyes with recent onset (less than 12 weeks) BRVO. Participants were randomly assigned to two treatment groups: the IVB group (43 eyes) consisted of patients who received monthly injections of 1.25 mg IVB, and the IVT group (43 eyes) comprised of patients who received 2 injections of 2 mg IVT two months apart. Patients were examined 1, 2, 3, 4, and 6 months after enrollment. The 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. Mean BCVA improved significantly up to 6 months in both groups from 0.250.68 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 groups). However, inter-group differences reached significant levels 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 was statistically significant (P=0.031) at final visit. Dividing the cases into ischemic and non-ischemic types, a significant difference was noted only in 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. Both 3 times monthly IVB injections and 2 times IVT injections with two 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.