Predictors of macular edema recurrence and visual outcomes in branch retinal vein occlusion treated with aflibercept or ranibizumab.

Purpose: To investigate the risk factors for visual outcomes and recurrence of macular edema (ME) in branch retinal vein occlusion (BRVO) after intravitreal injection (IVI) of anti-vascular endothelial growth factor (anti-VEGF) agents.

Methods: Thirty eyes of 30 patients with recent-onset, treatment naive BRVO with ME receiving IVI aflibercept and ranibizumab in a tertiary care hospital were enrolled retrospectively. Treatment response was classified into "responsive group" and "recurrent/refractory group" by absence or presence of ME after consecutive monthly IVI anti-VEGF therapy. The correlation between the optical coherent tomography and fluorescein angiography features and treatment response was analyzed during a 1-year follow-up period.

Results: In thirty eyes, the logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA) improved from 0.69 ± 0.39 to 0.55 ± 0.48, and was comparable in the responsive and recurrent/refractory groups (p = 0.683). At baseline, the recurrent group had a higher prevalence of subretinal fluid (SRF), disruption in the ellipsoid zone, and greater central macular thickness (CMT) than in the responsive group. Worse initial BCVA, presence of intraretinal fluid (IRF) and external limiting membrane disruption at the third month after treatment was associated with poorer final BCVA (p = 0.021, 0.014, and 0.044, respectively). Cases receiving three consecutive loading injections indicated better final BCVA (p = 0.008). Patients receiving aflibercept required fewer injections than those receiving ranibizumab (p = 0.005).

Conclusions: Baseline predictors of ME recurrence included SRF presence, outer retinal layer disruptions, and greater CMT. Baseline vision, IRF at 3rd month, and the number of consecutive loading injection were correlated with visual outcomes.