Intravitreal Bevacizumab vs Sub-Tenon Triamcinolone Acetonide for Choroidal Neovascularization Attributable to Pathologic Myopia

PURPOSE: To compare the visual outcomes of intravitreal bevacizumab (Avastin; Genentech Inc, South San Franciso, California, USA) and sub Tenon triamcinolone acetonide (TA) for choroidal neovascularization attributable to pathologic myopia (mCNV). DESIGN: Retrospective, comparative, interventional case series. METHODS: Fifty-four consecutive eyes of 53 patients with mCNV treated with either sub-Tenon TA or intravitreal bevacizumab in an institutional setting were included. Twenty eyes were treated with sub,Tenon TA and 34 eyes were treated with intravitreal bevacizumab. The main outcome measures included best-corrected visual acuity (BCVA) 12 months after the initial injection and logarithm of the minimum angle of resolution gain from baseline compared with analysis of covariance (ANCOVA). RESULTS: At 12 months, the BCVA improved by 1.9 lines in the intravitreal bevacizumab group and worsened by 0.3 lines in the sub Tenon TA group. Thus, the intravitreal bevacizumab group had significantly greater visual improvement than the sub,Tenon TA group (P < .01). Statistical analysis (ANCOVA) revealed that age (P = .01), pretreatment BCVA (P < .01), and the treatment choice (intravitreal bevacizumab or sub-Tenon TA; P < .01) correlated significantly with the BCVA and the BCVA gain at 12 months. The refractive error was of borderline significance (P = .06). CONCLUSIONS: Although this study is limited be. cause of its retrospective nature, intravitreal bevacizumab seems to result in a more favorable visual outcome than sub Tenon TA in the treatment of mCNV. Patient age, the BCVA before treatment, and the refractive error must be considered to initiate the treatment. (Am J Ophthalmol 2009;148:591-596. (C) 2009 by Elsevier Inc. All rights reserved.)