Combined Intravitreal Anti-VEGF Agent and ROCK inhibitor Injection for Macular Edema Secondary to retinal Vein Occlusion Randomized Clinical Trial.

Purpose: To compare the anatomical and functional outcomes of intravitral injection of bevacizumab and fasudil with intravitreal injection of bevacizumab alone in patients with macular edema secondary to RVO. Methods: In this randomized controlled clinical trial patients with RVO and macular edema were enrolled and randomized to two groups. Combined group received three monthly intravitreal injections of bevacizumab and fasudil. Bevacizumab group received three monthly intravitreal bevacizumab. Patients were followed monthly for 12 months and if retreatment was needed intravitreal bevacizumab was injected. Main outcome measure was best corrected visual acuity (BCVA) changes and secondary outcome measure was central macular thickness (CMT) changes. Results: The data of 20 patients in the combined group and 15 patients in the bevacizumab group were analyzed. Baseline BCVA and CMT were 0.74±0.51, 0.8±0.54 logMAR and 537±254, 487±143 μm in the combined group and bevacizumab group respectively. There was not significant difference between groups in terms of BCVA and CMT. BCVA and CMT in the last follow up visit were 0.58±0.40 logMAR, 416±211 μm and 0.47±0.39 logMAR, 366±105 μm in the combined group and bevacizuma group respectively. BCVA improvement was significant at month 3 ( p= 0.004) and 12 ( p=0.011) in the combined group while the BCVA improvement was not significant at moth 3,6 and 12. ( p=0.138,p= 0.205 and p=0.326) in the bevacizumab group. CMT reduction was significant at month 6 (p= 0.002) and 12 (p=0.03) in the combined group while CMT reduction was not significant at month 3,6 and 12 ( p=0.063, p= 0.808 and p= 0.068) in the bevacizumab group. No systemic and ocular side effect were observed in each group. Conclusion: Combined intravitreal injection of anti-VEGF and ROCK inhibitor may enhance and prolong the functional and anatomical effects of intravitreal anti-VEGF agents in patients with macular edema secondary to RVO.