We read with interest the study by Gündüz and Bakri.1 The authors conclude that intravitreal bevacizumab (IVB) is effective in treating macular oedema associated with branch retinal vein occlusion. However, we suggest that the results ought to be interpreted cautiously for the reasons given below.
The patients involved in this study were heterogeneous with respect to factors that may influence the outcome of treatment with IVB. For example, one-third of the patients were found to have macular ischaemia, and this may account for some of the variability. The impact of the wide range of patients’ ages and of relevant coexisting pathologies, such as diabetes mellitus and glaucoma, was not quantified. Some of the eyes underwent initial laser or intravitreal/posterior subtenon triamcinolone, which may have influenced the efficacy of IVB. Finally, as the authors do not state quantitative criteria for IVB retreatment, it is difficult for readers to determine a protocol that might produce similar results for their own patients.
We are encouraged by the outcomes reported, but suggest that detailed analysis of the subjects being treated and comparison with matched controls should be undertaken before IVB can be recommended for this indication. Future studies could also distinguish between the potential for IVB as a primary treatment, perhaps before structural or ischaemic changes at the macula have become established, and its role as a second- or third-line therapy.
References
Gündüz K, Bakri SJ . Intravitreal bevacizumab for macular oedema secondary to branch retinal vein occlusion. Eye 2008; 22 (9): 1168–1171.
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Hu, K., Horgan, S., Sivaraj, R. et al. Intravitreal bevacizumab for macular oedema secondary to branch retinal vein occlusion: more data required. Eye 24, 194 (2010). https://doi.org/10.1038/eye.2009.27
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DOI: https://doi.org/10.1038/eye.2009.27
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