Potential sustained benefits of early targeted panretinal photocoagulation in combination with anti-VEGF in macular edema secondary to retinal vein occlusion: 48-month results of a retrospective comparative study

TL;DR

Combining early laser treatment with anti-VEGF injections may offer long-term benefits for retinal vein occlusion patients with macular edema, especially those with severe retinal ischemia.

Contribution

First study to report 48-month outcomes of early targeted PRP combined with anti-VEGF therapy in ischemic RVO.

Findings

Combined therapy showed a trend toward better anatomical and visual outcomes in patients with severe retinal ischemia.

Early PRP did not reduce the number of anti-VEGF injections required over 48 months.

Baseline ischemic index (IsI) quantification is important for managing RVO effectively.

Abstract

To evaluate the long-term benefit of early targeted panretinal photocoagulation (PRP) combined with anti-VEGF therapy (IVL group) versus anti-VEGF monotherapy (IV group) in treatment-naïve eyes with macular edema (ME) secondary to ischemic RVO.

A retrospective analysis of 143 patients (85 IVL, 58 IV) with ischemic RVO. Baseline ischemic index (IsI), central retinal thickness (CRT), best-corrected visual acuity (BCVA), and age were adjusted.

Over 48 months, the IVL group showed a reduction in mean CRT from 475.6 ± 117.3 μm to 282.0 ± 69.5 μm and improved BCVA from 0.61 ± 0.34 LogMAR to 0.44 ± 0.34 LogMAR. The IV group demonstrated CRT reduction from 479.4 ± 135.5 μm to 340.9 ± 127.3 μm and BCVA improvement from 0.58 ± 0.32 LogMAR to 0.50 ± 0.43 LogMAR. The IVL group received 26.0 ± 8.6 intravitreal anti-VEGF treatments (IVT), compared to 25.5 ± 6.2 IVT in the IV group.

The IVL group exhibited a trend toward better treatment response, particularly in patients with severe retinal ischemia, though findings were not statistically significant. Baseline IsI quantification is recommended for optimal RVO management.

The online version contains supplementary material available at 10.1186/s12886-025-04496-9.

What is known:

The benefit of adjuvant targeted panretinal photocoagulation (PRP) combined with intravitreal anti-VEGF treatment for macular edema (ME) secondary to ischemic retinal vein occlusion (RVO) remains controversial.Limited evidence suggests that early, targeted PRP of the ischemic peripheral retina may improve visual acuity (VA) and ME response to anti-VEGF treatment.

The benefit of adjuvant targeted panretinal photocoagulation (PRP) combined with intravitreal anti-VEGF treatment for macular edema (ME) secondary to ischemic retinal vein occlusion (RVO) remains controversial.

Limited evidence suggests that early, targeted PRP of the ischemic peripheral retina may improve visual acuity (VA) and ME response to anti-VEGF treatment.

What is new:

This is the first study to report long-term outcomes of combined early targeted PRP and anti-VEGF therapy versus anti-VEGF monotherapy in 143 eyes with ischemic RVO.Combined therapy showed a trend toward improved anatomical outcomes, particularly in patients with baseline ischemic index (IsI) ≥ 15%.Early PRP did not reduce the treatment burden, including the number of anti-VEGF injections.Quantifying IsI at baseline is crucial for assessing retinal ischemia severity in RVO.

This is the first study to report long-term outcomes of combined early targeted PRP and anti-VEGF therapy versus anti-VEGF monotherapy in 143 eyes with ischemic RVO.

Combined therapy showed a trend toward improved anatomical outcomes, particularly in patients with baseline ischemic index (IsI) ≥ 15%.

Early PRP did not reduce the treatment burden, including the number of anti-VEGF injections.

Quantifying IsI at baseline is crucial for assessing retinal ischemia severity in RVO.

The online version contains supplementary material available at 10.1186/s12886-025-04496-9.

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