Evaluation of intravitreal aflibercept injected alone against aflibercept with triamcinolone acetonide for management of macular edema secondary to retinal vein occlusion

Aim The aim of this study was to evaluate the intravitreal injection of aflibercept alone compared to combined aflibercept with triamcinolone acetonide (TA) in the management of macular edema (ME) secondary to retinal vein occlusion (RVO). Patients and methods This is a prospective comparative study that included 40 cases with ME secondary to RVO. They were divided into two equal groups each of 20 eyes. Group 1 were managed by intravitreal injection of aflibercept (Elyea) alone, while group 2 were treated by aflibercept plus TA. All cases were examined preoperatively and during the follow-up visits of 1 day, 1 week, and 1, 3, 6, and 12 months postinjection. The outcome measures were visual acuity (VA), intraocular pressure (IOP), central macular thickness (CMT) with optical coherence tomography, number of injections, and postoperative complications. Results The mean age of groups 1 and 2 was 46.33±4.5 and 47.25±5.25 years, respectively. Both groups were matched in age and sex ( P >0.05). Central RVO was observed in 11 (55%) and 12 (60%) eyes in groups 1 and 2, respectively. The difference was statistically insignificant ( P =0.879). Branch RVO was observed in nine (45%) and eight (40%) eyes in groups 1 and 2, respectively, with no statistically significant difference ( P =0.745). The VA was significantly improved from baseline to 3 months postinjection in both groups. However, it was more significantly improved in group 2 compared to group 1 at 3-, 6-, and 12-month postinjection ( P <0.001). The IOP was elevated on the first day postinjection, especially in group 2. Then, it started to decrease by the end of the first week to reach the normal ranges by the first month. However, group 2 showed an increased IOP more than group 1 without a statistically significant difference ( P >0.05). The CMT was significantly decreased from baseline to 1-month postinjection in both groups and continued to decrease till the end of the follow-up period ( P <0.001). However, the effect was more marked in group 2 compared to group 1, with a statistically significant difference ( P <0.05). Group 2 cases required significantly less number of injections than group 1 ( P <0.05). The interval between injections was also shorter in group 1 than in group 2, with statistically significant differences at 3 and 4 weeks ( P <0.001). Most eyes in group 2 had longer intervals between the injections with a statistically significant difference at 8 weeks ( P <0.001). Conclusion Both aflibercept and aflibercept plus TA were efficient in the management of ME secondary to RVO. However, the outcome of combined therapy was better regarding the VA and the decrease in CMT, with a smaller number of injections. On the other hand, aflibercept showed more safety regarding the elevation of the IOP.