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

Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.