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.