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COMPARISON OF TWO DOSES OF INTRAVITREAL BEVACIZUMAB AS PRIMARY TREATMENT FOR MACULAR EDEMA SECONDARY TO BRANCH RETINAL VEIN OCCLUSIONS: Results of the Pan American Collaborative Retina Study Group at 24 Months

WU, LIHTEH MD*; AREVALO, J FERNANDO MD; BERROCAL, MARIA H. MD; MAIA, MAURICIO MD§; ROCA, JOSÉ A. MD; MORALES-CANTÓN, VIRGILIO MD**; ALEZZANDRINI, ARTURO A. MD††; DÍAZ-LLOPIS, MANUEL J. MD‡‡

doi: 10.1097/IAE.0b013e3181bcef53
Original Articles

Purpose: The purpose of this study was to compare the injection burden, central macular thickness (CMT), and change in best-corrected visual acuity (BCVA) after injecting 1.25 mg or 2.5 mg of bevacizumab as needed in patients with primary macular edema secondary to branch retinal vein occlusion.

Methods: An interventional, retrospective, comparative multicenter study was conducted of 63 eyes with macular edema secondary to branch retinal vein occlusion that were treated primarily with intravitreal bevacizumab (38 eyes, 1.25 mg; 25 eyes, 2.5 mg). The main outcome measures were the CMT and the change of BCVA at 24 months.

Results: All patients completed at least 24 months of follow-up. The mean number of injections per eye was 3.6 in the 1.25-mg group and 4.3 in the 2.5-mg group (P = 0.4770). At 24 months, in the 1.25-mg group, the logarithm of the minimum angle of resolution BCVA improved from baseline 0.38 ± 0.63 (P < 0.0001) units to 0.64 ± 0.6 units for the 2.5-mg group (P < 0.0001). In the 1.25-mg group, 26 (68%) eyes gained ≥3 of Early Treatment of Diabetic Retinopathy Study visual acuity and 2 (5%) eyes lost ≥3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity. In the 2.5-mg group, 18 (72%) eyes improved ≥3 of Early Treatment of Diabetic Retinopathy Study visual acuity, and none of the eyes lost ≥3 lines of Early Treatment of Diabetic Retinopathy Study visual acuity. The CMT in the 1.25-mg group improved from 453 ± 140 μm to 244 ± 125 μm (P < 0.0001) versus 444 ± 175 μm to 234 ± 80 μm in the 2.5-mg group (P < 0.0001). There were no cases of endophthalmitis. No systemic adverse events were reported.

Conclusion: Intravitreal bevacizumab at doses up to 2.5 mg seems to be effective in improving BCVA and reducing CMT in macular edema secondary to branch retinal vein occlusion. No statistically significant differences were found between the two dose groups with regard to the number of injections, CMT, and change in BCVA.

Vascular endothelial growth factor inhibition up to 2 years appears to be beneficial in eyes with macular edema secondary to branch retinal vein occlusion. Reinjections will be necessary in a large number of eyes to maintain a lasting beneficial effect. Increasing the usual dose of 1.25 mg to 2.5 mg of bevacizumab does not appear to add any additional benefit in terms of visual acuity or injection burden.

From the *Instituto de Cirugia Ocular, San José, Costa Rica; †Retina and Vitreous Service, Clinica Oftalmológica Centro Caracas, Caracas, Venezuela; ‡University of Puerto Rico, San Juan, Puerto Rico; §Universidade Federal de São Paulo, Departamen to de Oftalmologia, Instituto da Visão, Sao Paulo, Brasil; ¶Clinica Ricardo Palma, Lima, Perú; **Asociación Para Evitar La Ceguera, Hospital Luis Sanchez Bulnes, Mexico City, Mexico; ††Oftalmos, Instituto Oftalmico de Alta Complejidad, Universidad de Buenos Aires, Buenos Aires, Argentina; and ‡‡Instituto Oftalmologico de Valencia, Valencia, Spain.

For a complete listing of participating members of Pan American Collaborative Retina Study Group, see the Appendix.

The authors have no financial interests in the subject matter presented.

Reprint requests: Lihteh Wu, MD, Apdo 144-1225 Plaza Mayor, San José, Costa Rica; e-mail: LW65@cornell.edu

© The Ophthalmic Communications Society, Inc.