This is a randomised, prospective, non-inferiority trial of 75 patients with macular oedema due to a branch retinal vein occlusion (BRVO) who received intravitreal injections of ranibizumab or bevacizumab after 1:1 block randomisation. This study is to measure the difference in the mean changes in the best corrected visual acuity (BCVA) at six months. The other outcome measured is to include the mean change in the central retinal thickness (CRT), the proportion of patients improving by >15 letters and the proportion of patients developing neovascularisation. From this study the IVR group of 37 patients or the IVB group of 38 patients received the anti-VEGF treatment and the mean BCVA at baseline was 52.8±14.4 letters (20/80) and 56.1±10 letters (20/80) (p=0.24) in the ranibizumab and bevacizumab groups respectively. At six months, the means gains in BCVA were +18.1 letters (p<0.0001) in the ranibizumab group and +15.6 letters (p<0.0001) in the bevacizumab group. The difference between the mean visual gains of the treated groups (bevacizumab-ranibizumab) was -2.5 letters (95% Cl -8.0 to +5.0; p=0.74). Mean reduction in central retinal thickness at six months were 177.1±122.3µ in the ranibizumab group (p<0.0001) and 201.7±166.2µ in the bevacizumab group (p<0.0001), with no significant difference between the two groups. The mean numbers of ranibizumab and bevacizumab injections were 3.2 and 3.1 respectively. Two serious adverse events occurred in the ranibizumab group and one in the bevacizumab group but both were unrelated to the intravitreal injections. The subjects in both treatment arms were eligible to receive modified macular grid laser photocoagulation at 12 weeks if the following pre-specified criteria were met: 1) >50µ thickness increase in central retinal thickness compared with the thinnest previous measurements, and 2) persistent diffuse oedema ≥250µ in the central retinal thickness. Whenever laser photocoagulation was performed, an anti-VEGF injection was also administered. The authors conclude that there is a significant gain in visual acuity in eyes with BRVO treated with either bevacizumab or ranibizumab. Pro-re-nata strategy was effective in maintaining the visual gain. The weaknesses of this study are the PRN treatment protocol may have limited the VA improvements in both treatment arms and also this is a relatively small trial. A larger population study should be considered in the future. 

A randomised, double-masked, controlled study of the efficacy and safety of intravitreal bevacizumab versus ranibizumab in the treatment of macular oedema due to branch retinal vein occlusion.
Narayanan R, Panchal B, Das T, et al.
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Jonathan Chan

Royal Hallamshire Hospital, Sheffield, UK.

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