Acetazolamide and bevacizumab combination therapy versus bevacizumab monotherapy in macular edema secondary to retinal vein occlusion

Purpose. - To determine and compare the efficacy of intravitreal bevacizumab (IVB) and oral acetazolamide (OA) combination therapy versus IVB monotherapy in patients with macular edema secondary to retinal vein occlusion (RVO).Methods. - This randomized clinical trial included 54 eyes of 52 patients with RVO central macular thickness (CMT) of more than 300 mu m, and best corrected visual acuity (BCVA) between 20/400 and 20/40. Eligible patients were randomly assigned to two groups: (I) IVB and OA (250 mg twice daily) combination therapy or (II) IVB monotherapy. Ocular injections were repeated monthly for up to three months; BCVA and CMT were measured monthly.Results. - Both regimens resulted in significant reduction in CMT (534 +/- 150 mu m to 352 +/- 90 mu m in the IVB + OA group, P < 0.001; and 580 +/- 175 mu m to 362 +/- 90 mu m in the IVB group, P < 0.001); neither showed superiority in this regard. Likewise, BCVA showed significant improvement in both groups (0.87 +/- 0.56 to 0.53 +/- 0.28 LogMAR in the IVB + OA group, P = 0.001; and 0.85 +/- 0.62 to 0.46 +/- 0.4 LogMAR in the IVB group, P < 0.001), with no intergroup difference.Conclusion. - Addition of oral acetazolamide to IVB in eyes with macular edema secondary to RVO may not result in additional short-term benefits regarding functional and anatomical outcomes. Trial registration: ClinicalTrials.gov, NCT05290948, registered on March 22, 2022. https://clinicaltrials.gov/ct2/show/NCT05290948 (c) 2023 Elsevier Masson SAS. All rights reserved.

Automated summary

This randomized clinical trial compared the efficacy of intravitreal bevacizumab (IVB) and oral acetazolamide (OA) combination therapy with IVB monotherapy in patients with macular edema secondary to retinal vein occlusion (RVO). The results showed that both regimens were effective in improving visual acuity and reducing macular thickness, but combination therapy did not provide additional short-term benefits.