Avastin as effective as steroid for refractory uveitic CME Intravitreal Avastin (bevacizumab, IVB) was as effective as intravitreal steroid (triamcinolone acetonide, IVT) at improving vision in patients with refractory uveitic cystoid macular edema (CME).

Cystoid macular edema (CME) is the most common cause of significant vision loss in patients with uveitis. Medical treatment of CME includes non-steroid anti-inflammatory drugs (topical and systemic), corticosteroids (topical, periocular, intravitreal, and systemic), and systemic carbonic anhydrase inhibitors. In some patients, however, CME is resistant to these treatments, despite successful control of uveitis.

In this randomized clinical trial, 31 eyes with uveitic CME were allocated into the IVB group—eyes that received 1–3 injections of 1.25 mg Avastin (15 eyes) and the IVT group—eyes that received 1–3 injections of 2 mg triamcinolone (16 eyes). Primary outcome measure was change in best-corrected visual acuity (VA) at 36 weeks.

Visual acuity improvement compared with baseline values was meaningful in the IVB group at 12, 24, and 36 weeks (-0.35 ± 0.45 logMAR [P = 0.016]) and in the IVT group at 24 and 36 weeks (-0.32 ± 0.32 logMAR [P = 0.001]). A significant central macular thickness (CMT) reduction was observed only in the IVT group at week 36 (74.6 ± 108.0 µm [P = 0.049]). Between-group analysis disclosed no significant difference in any outcome measure. By statistically removing the factor of cataract, the IVT group had more improvement in VA (P = 0.007).

The investigators conclude that Avastin was as effective as steroid in refractory uveitic CME regarding VA improvement up to 36 weeks. These results are consistent with previous research.

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J Ocul Pharmacol Ther. 2010 Mar 22. [Epub ahead of print]