three intravitreal bevacizumab versus two intravitreal triamcinolone injections in recent onset branch retinal vein occlusion

purpose: to compare repeated intravitreal injections of bevacizumab (ivb) with triamcinolone acetonide (ivt) for treatment of acute branch retinal vein occlusion (brvo). methods: 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. results: 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. conclusion: 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.