Study on the Timing of Combined Anti-VEGF Therapy and Focal Retinal Photocoagulation for Branch Retinal Vein Occlusion

Abstract

Objective: To explore the optimal timing for focal retinal photocoagulation following conventional intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO), so as to provide evidence for individualized clinical management. Methods: A retrospective analysis was performed on 65 patients (67 eyes) diagnosed with BRVO complicated with ME admitted to the Department of Ophthalmology, Inner Mongolia Forest General Hospital from January 2020 to December 2022. According to findings of fundus fluorescein angiography (FFA), enrolled subjects were divided into non-perfusion zone group (34 patients, 36 eyes with non-perfusion area ≥5 DD) and neovascularization group (31 patients, 31 eyes). All patients received intravitreal ranibizumab injection followed by focal retinal photocoagulation one week after anti-VEGF treatment. All subjects were followed up for 3 months. Changes in best-corrected visual acuity (BCVA), central retinal thickness (CRT), absorption of retinal hemorrhage and incidence of adverse events were compared between two groups. Results: BCVA was significantly improved and CRT was markedly reduced after treatment in both groups (P<0.05). At 1 month post-treatment, the non-perfusion zone group achieved superior improvements in BCVA (0.60±0.21) and CRT (234.75±54.75 μm) compared with the neovascularization group (P<0.05). The incidence of vitreous hemorrhage was significantly higher in the neovascularization group (16.1%) than that in the non-perfusion zone group (0%, P<0.05). No statistically significant intergroup difference was observed in the absorption rate of retinal hemorrhage (P>0.05). Conclusion: Combined anti-VEGF and focal retinal photocoagulation is safe and effective for BRVO treatment. Early photocoagulation applied at the stage of non-perfusion lesion ≥5 DD facilitates better early visual function recovery and reduces the risk of severe complications such as vitreous hemorrhage, which serves as the preferred timing for clinical intervention.