ABSTRACT

To assess the efficacy of grid laser photocoagulation, intravitreal triamcinolone acetonide injection and intravitreal bevacizumab injection in patients with central retinal vein occlusion or branch retinal vein occlusion.

In a retrospective assessment, 78 eyes of 78 patients (in May 2008-May 2010) with central retinal vein occlusion or retinal vein occlusion were reviewed according to initial and final best-corrected visual acuity. Retinal vein occlusion was diagnosed with fundus examination and fundus fluorescein angiography. Cases who have additional ocular pathologies and neovascularization were excluded from the study. Grid laser photocoagulation was performed in 50 eyes, 4 mg intravitreal triamcinolone acetonide injection was performed in 8 eyes and 1.25 intravitreal bevacizumab injection was performed in 20 eyes. The best visual acuity was assessed before and after treatment. Best corrected visual acuity values obtained with Snellen were translated into logMAR units. At least one logMAR unit improvement in the visual acuity was considered a success.

Thirty three patients (40%) were male and 47 (60%) were female. The average age of the patients was 61 years (44-78 years). Sixty five patients had branch retinal vein occlusion, 13 had central retinal vein occlusion. Fifty five patients (71%) had perfused type and 23 patients (29%) had ischemictype vein occlusion. Thirty four (44%) patients had hypertension, 26 (33%) patients had diabetes mellitus. The average observational period was 10.5 months (1-24 months). Initial visual acuity was 1.12 LogMAR in the CRVO group, while it was 1.08 LogMAR in the BRVO group. Mean final best-corrected visual acuity was 0.58 LogMAR in the CRVO group, 0.52 LogMAR in the BRVO group. There is a statistically significant increase in visual acuities in all three groups (p=0.0). For CRVO group, average visual acuity increase was 0.54 LogMAR with grid laser photocoagulation, 0.56 LogMAR with triamcinolone acetonide and 0.57 LogMAR with bevacizumab. For BRVO group, it was 0.52 LogMAR with grid laser photocoagulation, 0.58 LogMAR with triamcinolone acetonide and 0.63 LogMAR with bevacizumab. There was a statistically significant difference between grid laser photocoagulation group and bevacizumab group (p=0.0). There was no significant difference between the other treatments and intravitreal triamcinolone acetonide injection. There was no increase in intraocular pressure which can not be controlled with medical treatment. No major local or systemic complications were observed in the early period, depending on the applications.

In the treatment of retinal vein occlusion, grid laser photocoagulation, intravitreal triamcinolone acetonide and intravitreal bevacizumab injections are effective. Intravitreal bevacizumab injection induced more increase in visual acuity than grid laser photocoagulation. There was no statistically significant difference between intravitreal bevacizumab injection and intravitreal triamcinolone injection. Intravitreal bevacizumab therapy is an effective treatment method of retinal vein occlusion in the early period. (JAREM 2012; 2: 6-9)