Prospective Evaluation of Intravitreal Triamcinolone Acetonide Injection in Macular Edema Associated with Retinal Vascular Disorders

Intravitreal Diclofenac in the Treatment of Macular Edema Due to Branch Retinal Vein Occlusion

BACKGROUND AND OBJECTIVE

To evaluate the effect of a single dose of intravitreal diclofenac on macular edema (ME) due to branch retinal vein occlusion (BRVO).

PATIENTS AND METHODS

In this prospective, interventional case series, 15 eyes with BRVO and ME with central macular thickness (CMT) greater than 250 µm on spectral-domain optical coherence tomography (SD-OCT) were enrolled. All patients were given 0.05 mg/0.1 mL of intravitreal diclofenac under aseptic conditions and followed up for 3 months with respect to best-corrected visual acuity (BCVA), intraocular pressure (IOP), fundus fluorescein angiography, and CMT measured on OCT.

RESULTS

The mean visual acuity improved from 0.115 ± 0.03 preoperatively to 0.356 ± 0.29 at 3 months (P = .002). Mean line improvement was 2.2 ± 1.6. Mean preoperative CMT decreased from 453.2 µm ± 55.3 µm to 340.47 µm ± 101 µm at 3 months postoperatively (P = .001). The mean preoperative IOP was 16.4 mm Hg ± 1.59 mm Hg, whereas the mean postoperative IOP was 16.6 mm Hg ± 1.58 mm Hg (P = .08). None of the 12 phakic eyes showed evidence of cataract progression.

CONCLUSION

Intravitreal diclofenac is safe and effective in improving BCVA and decreasing CMT in patients with BRVO and ME.

Comparison between Intravitreal Triamcinolone with Grid Laser Photocoagulation versus Bevacizumab with Grid Laser Photocoagulation Combinations for Branch Retinal Vein Occlusion

Purpose. To compare the efficacy of intravitreal triamcinolone (IVT) and intravitreal bevacizumab (IVB), both combined with grid laser photocoagulation (GLP) for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods. Retrospective, comparative study. The newly diagnosed patients with ME secondary to BRVO who were treated with IVT and GLP or IVB and GLP were included. The main outcome measures were changed in the best corrected visual acuity (BCVA) and central retinal thickness (CRT) from the baseline to month 24. Results. Ninety-nine eyes of 99 patients were included. The change in BCVA was not statistically different in any time points between the two groups (P > 0.05, for all). The change in CRT was not statistically different in any time points between the two groups (P > 0.05, for all). The mean number of injections at month 24 was 2.38 ± 1.06 in the IVT+GLP group and 4.17 ± 1.30 in the IVB+GLP group (P = 0.0001). The need for cataract surgery (P = 0.01) and secondary glaucoma (P = 0.03) occurrence were more common in IVT group. Conclusion. Both treatment modalities were effective in the treatment of ME secondary to BRVO. The number of injections was significantly lower in the IVT group than in the IVB group; however cataract and secondary glaucoma were more frequent in the IVT+GLP group than in the IVB+GLP group.

Branch retinal vein occlusion: treatment modalities: an update of the literature

BACKGROUND

Retinal vein occlusion is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. In this review, our purpose is to update the literature about the treatment alternatives for branch retinal vein occlusion.

METHODS

Eligible papers were identified by a comprehensive literature search of PubMed, using the terms "branch retinal vein occlusion," "therapy," "intervention," "treatment," "vitrectomy," "sheathotomy," "laser," "anti-VEGF," "pegaptanib," "bevacizumab," "ranibizumab," "triamcinolone," "dexamethasone," "corticosteroids," "non-steroids," "diclofenac," "hemodilution," "fibrinolysis," "tPA," and "BRVO." Additional papers were also selected from reference lists of papers identified by the electronic database search.

RESULTS

Treatment modalities were analyzed.

CONCLUSIONS

There are several treatment modalities for branch retinal vein occlusion and specifically for its complications, such as macular edema, vitreous hemorrhage, retinal neovascularization, and retinal detachment, including anti-aggregative therapy and fibrinolysis, isovolemic hemodilution, vitrectomy with or without sheathotomy, peripheral scatter and macular grid retinal laser therapy, non-steroid agents, intravitreal steroids, and intravitreal anti-vascular endothelial growth factors (anti-VEGFs).

Intravitreal bevacizumab alone or combined with triamcinolone acetonide as the primary treatment for diabetic macular edema

Purpose:

To compare the efficacy of intravitreal injection of bevacizumab alone or combined with intravitreal triamcinolone as the primary treatment for cases with diabetic macular edema (DME).

Methods:

Ninety eyes were enrolled in one of the three study arms; where intravitreal triamcinolone acetonide (IVT) was used in group I, IVT/intravitreal bevacizumab (IVT/IVB) in group II, and IVB in group III. The visual acuity (VA) and central macular thickness (CMT) were used as the outcome measures, where the results of each group were calculated and compared with the results of the other.

Results:

There was significant improvement in the VA in the three study groups at weeks 6 and 12; with regards to the intraocular pressure (IOP), there was significant difference at week 6 in the IVT and IVT/IVB groups, and at week 12 in IVT/IVB group, and nonsignificant difference at week 6 in the IVB group and at week 12 in IVT and IVB groups.

Conclusion:

From this study, we conclude that IVB is an effective drug for treatment of DME, and has a long lasting effect when compared with IVT and when compared with combined IVT/IVB; adding IVT does not affect the outcome measures except for elevating the IOP in treated patients in the early post-injection period.

[Long-term clinical outcome of radial optic neurotomy]

PURPOSE

To study the long-term clinical outcome through assessment of anatomical and functional results, as well as complications of eyes affected with central retinal vein occlusion (CRVO) that underwent radial optic neurotomy (RON).

METHODS

Retrospective, observational and descriptive study of 47 eyes corresponding to 47 patients affected by CRVO. All the eyes underwent RON performed by the same surgeon since 2002. The main assessed variables were visual acuity (VA), intraocular pressure (IOP), presence of iris neovascularization and opticocilliary veins, vascular recanalization and complications derived from this pathological entity.

RESULTS

Surgery was performed in 47 eyes, 21 of them (44.7%) were right sided and 26 left sided (55.3%). Mean age was 58.97 years. Mean post-surgical follow-up was 32.15 months. A total of 70.2% of the patients experienced stabilization or VA improvement, 23.4% iridian neovascularisation and 42.6% developed opticocilliary veins in the head of the optical nerve.

CONCLUSIONS

It is noticeable that in selected cases, RON produces a quick resolution of the retinal haemorrhage and papillary congestion and may improve the retinal perfusion. Long-term benefits are stabilization or improvement of the VA and a reduction in complications on the natural history in CRVO.

Tumor volume reduction using combined phacoemulsification and intravitreal triamcinolone injection for the management of cataract with treated uveal melanoma and atypical nevi

PURPOSE

To study the reduction in tumor size and the safety and efficacy of combined phacoemulsification and intravitreal triamcinolone acetonide injection (phaco-IVTA) in patients with treated melanoma and atypical nevi.

SETTING

Bascom Palmer Eye Institute, Miami, Florida, USA.

METHODS

The medical records of 49 consecutive patients (51 eyes) with treated melanoma or atypical nevi treated with phaco-IVTA were evaluated retrospectively for changes in Snellen visual acuity, tumor volume, and frequency of complications. Main outcome measures included a postsurgical change in tumor size greater than or equal to 0.5 mm of height or 1.0 mm of basal diameter by echographic analysis, improvement in visual acuity at 6 months and final follow-up, and complications including endophthalmitis, cystoid macular edema, epiretinal membrane, increased intraocular pressure, and persistent corneal edema.

RESULTS

The median baseline visual acuity was 20/80 in the affected eye. At the 6-month follow-up examination, 13 (68%) of 19 eyes had achieved better than 20/40 visual acuity. Treated uveal melanomas (n=30) and atypical choroidal nevi (n=21) were stable with combined therapy, and echographic measurements improved in 12 eyes. Intraocular pressure increased from baseline to 25 mm Hg or more postoperatively in 4 of 51 eyes (8%). No other significant complications occurred.

CONCLUSIONS

Combined phacoemulsification and IVTA was reasonably safe in patients with treated melanoma and atypical nevi. Tumors remained stable or decreased slightly in size. Intravitreal triamcinolone acetonide injection at the time of cataract surgery in patients with treated melanoma or nevus may reduce rates of tumor progression in these patients.

Use of intravitreal triamcinolone in the treatment of macular edema related to retinal vein occlusion

Objective:

To analyze the increasing trend of intravitreal triamcinolone (IVTA) use in the treatment of retinal vein occlusion-related macular edema.

Methods:

We performed MEDLINE/PUBMED searches (September 1984 - December 2007) to identify articles containing the keywords macular edema and triamcinolone. Case reports, reviews and abstracts were identified from references in the reviewed literature. This review focuses on literature published during the past 7 years with more than two-thirds of the articles that we reviewed being printed during the past 5 years. These reports analyzed the success of IVTA in the treatment of macular edema over a 12 month course of time.

Results:

The majority of studies suggested promising results for short time periods (4-6 months) after IVTA treatments. However, long term results were not encouraging.

Conclusions:

The success of IVTA therapy for short durations has been the impetus for development of sustained release devices to be used in the treatment of macular edema associated with various retinal diseases including edema related to retinal vein occlusion.

Frequency and risk factors for intraocular pressure elevation after posterior sub-Tenon capsule triamcinolone acetonide injection

PURPOSE

This study investigated the effects of posterior sub-Tenon capsule (PST) injection of triamcinolone acetonide (TA) on intraocular pressure (IOP) in the human eye.

METHODS

The study included 115 patients who received PST injections of 40-mg TA to treat macular edema with diabetic retinopathy (n=57), branch retinal vein occlusion (n=35), central retinal vein occlusion (n=13), or other disorders (n=10). IOP measurements were performed on the day of injection, and 0.5, 1, 2, 3, 6, 9, and 12 months later.

RESULTS

In 26 (22.6%) of the 115 eyes, an IOP of 24 mm Hg or higher was observed during the 12-month follow-up period after PST TA injection. IOP elevation significantly correlated with young age, but not with past history of diabetes mellitus or systemic hypertension, sex, or type of retinal disease with macular edema. In total, 23 eyes were treated with antiglaucoma medications to control elevated IOP (24 mm Hg or higher). External trabeculotomy was performed in 1 case where medications failed to correct elevated IOP.

CONCLUSIONS

PST TA injection is associated with high rates of steroid-induced IOP elevation in eyes with previously normal IOP. However, IOP elevation may be less common after PST injection than after intravitreal injection. Our findings indicate that IOP must be carefully monitored after PST TA injection.

Intravitreal bevacizumab (avastin) for central and hemicentral retinal vein occlusions: IBeVO study

PURPOSE

To evaluate the safety, visual acuity changes, and morphologic effects associated with intravitreal bevacizumab injections for the management of macular edema due to ischemic central or hemicentral retinal vein occlusion (RVO).

METHODS

In this prospective, open-label study, 7 consecutive patients (7 eyes) with macular edema associated with ischemic central or hemicentral RVO were treated with intravitreal injections of 2.0 mg (0.08 mL) of bevacizumab at 12-week intervals. Standardized ophthalmic evaluation was performed at baseline and at weeks 1, 6, and 12 after each injection. Clinical evidence of toxicity and complications as well as changes in logarithm of minimum angle of resolution Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), central macular thickness (CMT) and total macular volume (TMV) shown by optical coherence tomography (OCT), and dye leakage shown by fluorescein angiography were evaluated.

RESULTS

The median age of the 7 patients was 65 years (range, 58-74 years), and the median duration of symptoms before injection was 7 months (range, 2.5-16 months). At baseline, mean BCVA was 1.21 (Snellen equivalent, approximately 20/320) in the affected eye. Mean baseline CMT and TMV were 730.1 microm and 17.1 mm(3), respectively. Fluorescein leakage was observed in the macula and affected retinal quadrants in all seven eyes. Six patients completed the 25-week follow-up examination with reinjections performed at weeks 12 and 24. The most common adverse events were conjunctival hyperemia and subconjunctival hemorrhage at the injection site. At the last follow-up, mean BCVA in the affected eye was 0.68 (Snellen equivalent, 20/100(+1). No patient had a decrease in BCVA. Mean CMT and TMV at the 25-week follow-up were 260.3 microm and 9.0 mm(3), respectively; fluorescein leakage within the macula and affected retinal quadrants as compared with baseline was markedly reduced in all patients. Coupled with fluorescein angiographic findings, OCT data suggest a trend of macular edema recurrence between 6 weeks and 12 weeks after injection.

CONCLUSIONS

Intravitreal bevacizumab injections of 2.0 mg at 12-week intervals were well tolerated and were associated with short-term BCVA stabilization or improvement and favorable macular changes in all patients with ischemic RVO and associated macular edema.

Interventions for branch retinal vein occlusion: an evidence-based systematic review

TOPIC

To assess the evidence on interventions to improve visual acuity (VA) and to treat macular edema and/or neovascularization secondary to branch retinal vein occlusion (BRVO).

CLINICAL RELEVANCE

Branch retinal vein occlusion is the second most common retinal vascular disease.

METHODS/LITERATURE REVIEWED

English and non-English articles were retrieved using a keyword search of Medline (1966 onwards), Embase, the Cochrane Collaboration, the National Institute of Health Clinical Trials Database, and the Association for Research in Vision and Ophthalmology Annual Meeting Abstract Database (2003-2005). This was supplemented by hand searching references of review articles. Two investigators independently identified all randomized clinical trials (RCTs) with more than 3 months' follow-up.

RESULTS

From 4332 citations retrieved, 12 RCTs were identified. There were 5 RCTs on laser photocoagulation. Grid macular laser photocoagulation was effective in improving VA in 1 large multicenter RCT, the Branch Vein Occlusion Study (BVOS), but 2 smaller RCTs found no significant difference. The BVOS showed that scatter retinal laser photocoagulation was effective in preventing neovascularization and vitreous hemorrhage in patients with neovascularization, but a subsequent RCT found no significant effect. Randomized clinical trials evaluating intravitreal steroids (n = 2), hemodilution (n = 3), ticlopidine (n = 1), and troxerutin (n = 1) showed limited or no benefit.

CONCLUSIONS

There is limited level I evidence for any interventions for BRVO. The BVOS showed that macular grid laser photocoagulation is an effective treatment for macular edema and improves vision in eyes with VA of 20/40 to 20/200, and that scatter laser photocoagulation can effectively treat neovascularization. The effectiveness of many new treatments is unsupported by current evidence.

Interventions for Central Retinal Vein Occlusion

TOPIC

To assess the evidence for the effectiveness of interventions to improve visual acuity (VA) and prevent or treat neovascularization secondary to central retinal vein occlusion (CRVO).

CLINICAL RELEVANCE

Central retinal vein occlusion is a common cause of visual morbidity and blindness. Many different interventions have been advocated, but the evidence justifying their use remains unclear.

METHODS/LITERATURE REVIEWED

English and non-English language articles were retrieved using a keyword search of Medline (1966 onwards), Embase, the Cochrane Collaboration, the National Institutes of Health Clinical Trials database, and the Association for Research in Vision and Ophthalmology (2003-2005). This was supplemented by manually searching references of review articles. Two investigators independently identified all randomized clinical trials (RCTs) on interventions in CRVO with more than 3 months' follow-up.

RESULTS

Of 4133 citations retrieved, 17 RCTs comparing intervention with a control group were identified. There were 4 RCTs on laser photocoagulation. Grid macular laser photocoagulation did not improve VA in CRVO with macular edema. Prophylactic panretinal photocoagulation did not prevent angle and iris neovascularization in ischemic CRVO, but resulted in regression of angle and iris neovascularization and reduced progression to neovascular glaucoma. There were 4 RCTs that reported improvement in VA with inpatient hemodilution, 2 RCTs with no significant improvement, and 1 RCT showing deterioration in VA after outpatient hemodilution. Randomized clinical trials evaluating ticlodipine, troxerutin, and streptokinase showed a limited or no benefit.

CONCLUSIONS

This review found limited level I evidence for any intervention to improve VA in patients with CRVO. Panretinal photocoagulation resulted in regression of neovascularization. Hemodilution may improve vision in some patients, but the data conflict. More robust randomized controlled trials evaluating current treatments for CRVO are needed. The results of ongoing RCTs on intravitreal triamcinolone, anti-vascular endothelial growth factor agents, and chorioretinal anastomosis are awaited with interest.

Intravitreal triamcinolone as an adjunct in the treatment of concomitant proliferative diabetic retinopathy and diffuse diabetic macular oedema

PURPOSE

To investigate if triamcinolone acetonide (TA) can be an adjunct to laser treatment in patients with concomitant non-high-risk proliferative diabetic retinopathy (PDR) and diffuse clinically significant diabetic macular oedema (CSMO).

METHODS

This prospective, interventional and comparative clinical study included 32 eyes of 16 patients with bilateral concomitant non-high-risk PDR and diffuse CSMO. Each patient received 4 mg intravitreal TA for the eye with worse visual acuity (study group) and macular focal and grid laser photocoagulation (MP) for the other eye (control group). One month later, each patient received four sessions of panretinal photocoagulation for both eyes plus MP for the eyes in the study group. The visual and angiographic results of both groups were compared.

RESULTS

In the study group, the mean visual acuity (VA) improved from 0.12 +/- 2.3 lines at the baseline to 0.19 +/- 3.1 (P = 0.004), 0.20 +/- 3.2 (P = 0.004), 0.19 +/- 3.6 (P = 0.009) and 0.19 +/- 3.3 lines (P = 0.091) at the 1-, 3-, 6- and 9-month follow-up intervals, respectively. The macular oedema was found to be resolved in 11 eyes (69%) and decreased in five eyes (31%). In the control group, the mean VA deteriorated progressively from 0.41 +/- 3.1 lines at the baseline to 0.20 +/- 3.1 lines (P = 0.026) at the end of the study and the macular oedema decreased only in three eyes (19%) at the sixth follow-up month.

CONCLUSIONS

During the follow-up period of the study, intravitreal TA as an adjunct in the treatment of concomitant non-high-risk PDR and diffuse CSMO led to a more-favourable clinical outcome than conventional laser treatment.

Advances in Imaging of the Optic Disc and Retinal Nerve Fiber Layer

In the past decade, three technologies for imaging the optic disc and retinal nerve fiber layer have become commercially available: 1) confocal scanning laser tomography with the Heidelberg retinal tomograph; 2) confocal scanning laser polarimetry with the GDx VCC; and 3) optical coherence tomography with the Stratus OCT. Each uses different principles of physics. Understanding the merits and limitations of each of these technologies requires familiarity with the principles of operation of each device. This knowledge should be considered a prerequisite for the appropriate clinical utilization of these devices and for accurate interpretation of their results.

Predictive factors for short-term visual outcome after intravitreal triamcinolone acetonide injection for diabetic macular oedema: an optical coherence tomography study

AIM

To evaluate the predictive factors for visual outcome after intravitreal triamcinolone acetonide injection to treat refractory diabetic macular oedema (DME).

METHODS

A retrospective chart review of patients with DME who met the following inclusion criteria was performed: clinically significant diabetic macular oedema, receipt of a 4 mg/0.1 ml intravitreal triamcinolone acetonide injection and an optical coherence tomography (OCT) of the macula performed up to 10 days before injection. All patients received a full ophthalmic examination including best-corrected Snellen visual acuity (VA). The main outcome measure was the mean change in vision 3 months after injection.

RESULTS

Data from 73 eyes of 59 patients were analysed. After a mean follow-up of 324 days, the mean change in vision was -0.075 logarithm of minimum angle of resolution (logMAR) units, with 27.3% improving > or =3 lines, 6.8% declining > or =3 lines and 60.2% remaining stable within 1 line of baseline vision. Statistical analysis was performed using multivariate generalised estimating equations on the basis of data from 52 eyes of 42 patients. Factors associated with an improvement in vision 3 months after injection were worse baseline VA (-0.27 logMAR units/unit increase in baseline VA, p = 0.002) and presence of subretinal fluid (-0.17 logMAR units, p = 0.06). The presence of cystoid macular oedema negatively affected the visual outcome (0.15 logMAR units, p = 0.03). In addition, the presence of an epiretinal membrane (ERM) was associated with less visual improvement. ERM modified the effect of baseline VA as demonstrated by a significant interaction between these two variables (0.34 logMAR units/unit increase in baseline VA, p = 0.04).

CONCLUSIONS

OCT factors and baseline VA can be useful in predicting the outcomes of VA 3 months after intravitreal triamcinolone acetonide injection in patients with refractory DME.

Intravitreal triamcinolone acetonide: a change in a paradigm

BACKGROUND

Based on experimental studies and clinical observations by Robert Machemer, Gholam Peyman and others, the vitreous cavity has increasingly been used as a reservoir of drugs for the direct treatment of intraocular diseases.

METHODS AND RESULTS

The most widely injected drug so far has been triamcinolone acetonide for various intraocular neovascular and edematous diseases. Comparing the various diseases with respect to effect and side effects of the treatment, the best response in terms of gain in visual acuity has been achieved for intraretinal edematous diseases such as diffuse diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid macular edema. In eyes with various types of noninfectious uveitis including acute or chronic sympathetic ophthalmia and Adamantiadis-Behçet's disease, visual acuity increased and the degree of intraocular inflammation decreased. Some studies have suggested that intra- vitreal triamcinolone may be useful as an angiostatic agent in eyes with iris neovascularization and proliferative ischemic retinopathies. Intravitreal triamcinolone may possibly be helpful as adjunct therapy for exudative age-related macular degeneration, particularly in combination with photodynamic therapy. In eyes with chronic, therapy-resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure and may stabilize the eye. The complications of intravitreal triamcinolone therapy include secondary ocular hypertension in about 40% of the eyes injected; medically uncontrollable high intraocular pressure leading to antiglaucomatous surgery in about 1-2% of the eyes; posterior subcapsular cataract and nuclear cataract leading to cataract surgery in about 15-20% in elderly patients within 1 year after injection; postoperative infectious endophthalmitis with a rate of about 1:1,000; noninfectious endophthalmitis, perhaps due to a reaction to the solvent agent, and pseudoendophthalmitis with triamcinolone acetonide crystals appearing in the anterior chamber. Intravitreal triamcinolone injection can be combined with other types of intraocular surgery including cataract surgery, particularly in eyes with iris neovascularization. Cataract surgery performed some months after the injection does not show a markedly elevated complication rate. The injection may be repeated, if vision redecreases. In nonvitrectomized eyes, the duration of the effect and side effects of a single intravitreal injection of triamcinolone is about 6-9 months for a dosage of about 20 mg, and about 2-4 months for a dosage of 4 mg. It has remained unclear so far, whether and how to remove the solvent agent. In the future, intravitreal triamcinolone may be combined with other antiangiogenic drugs for the treatment of exudative age-related macular degeneration or with neuroprotective drugs for treatment of diabetic retinopathy.

CONCLUSIONS

Despite an exponentially increasing number of mostly case-series studies, the intravitreal injection of triamcinolone may still be considered an experimental procedure until randomized studies have been presented.

Intravitreal bevacizumab (Avastin) treatment of macular edema in central retinal vein occlusion: a short-term study

PURPOSE

To report the short term anatomic and visual acuity response after intravitreal injection of bevacizumab (Avastin, Genentech) in patients with macular edema due to central retinal vein occlusion (CRVO).

METHODS

The authors conducted a retrospective study of patients with macular edema due to CRVO who were treated with at least one intravitreal injection of bevacizumab 1.25 mg in 0.05 mL. Patients underwent Snellen visual acuity testing, optical coherence tomography (OCT) imaging, and ophthalmoscopic examination at baseline and follow-up visits.

RESULTS

There were 16 eyes of 15 consecutive patients with a mean age of 76.1 years (SD 9.8 years). Intravitreal triamcinolone had been previously administered to 9 patients, but all of these patients either had no improvement or had excessive intraocular pressure caused by the triamcinolone. The patients received a mean of 2.8 injections of bevacizumab per eye. No adverse events were observed, including endophthalmitis, clinically evident inflammation, increased intraocular pressure, retinal tears, retinal detachment, or thromboembolic events in any patient. The mean central macular thickness at baseline was 887 microm and decreased to a mean of 372 microm at month 1 (P < 0.001). The mean baseline acuity was 20/600 (logMAR = 1.48) and the mean acuity at month 1 was 20/200 (logMAR = 1.05), a difference that was highly significant (P = 0.001). At last follow-up, a mean of 3 months after the first injection, the mean visual acuity was 20/138 (logMAR = 0.84), which was significantly better than baseline (P < 0.001). Visual acuity improvement, defined as a halving of the visual angle, was seen in 14 of the 16 eyes.

CONCLUSION

Initial treatment results of patients with macular edema secondary to CRVO did not reveal any short-term safety concerns. Intravitreal bevacizumab resulted in a significant decrease in macular edema and improvement in visual acuity. The number of patients in this pilot study was limited and the follow-up is too short to make any specific treatment recommendations, but the favorable short-term results suggest further study is needed.