Comparison of Anti-VEGF Therapy and Corticosteroids in the Management of Uveitic Macular Edema

Abstract

Objective: To compare the anti-VEGF therapy and corticosteroids in improving best-corrected visual acuity (BCVA) and reducing central macular thickness (CMT) in UME patients. Study design and Setting: A Prospective Cohort Study conducted at Sindh Institute of Ophthalmology and Vision Sciences, Hyderabad Methodology: In this study 120 patients with UME were enrolled and 60 patients who received anti-VEGF Bevacizumab were placed Group A and those who were given Corticosteroids: intravitreal triamcinolone acetonide were placed in Group B. Primary outcomes were BCVA (logMAR), CMT and visual acuity improvement at 6 months. The secondary outcome was the total number of intravitreal injections administered per patient over 6 months, along with treatment-related adverse events. Results: Both groups showed significant within-group improvement in BCVA and CMT, with a significant Group × Time interaction for BCVA and CMT (p<0.001). The corticosteroid group had significantly greater CMT reduction at 1 month and all subsequent measurements (between group p<0.001) and greater improvement in the number of lines of visual acuity at 6 months (between group p=0.019); however, the between-group difference in continuous BCVA at 6 months was not significant (p=0.099). IOP elevation (p=0.002) and cataract progression (p=0.001) were significantly more common with corticosteroids. Conclusion: Intravitreal corticosteroid therapy was associated with greater anatomical improvement and a higher proportion of patients achieving clinically meaningful visual acuity gain compared with anti-VEGF therapy in uveitic macular edema, though this benefit came with a significantly higher risk of IOP elevation and cataract progression.