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Moon, Byung, Gil, MD*; Cho, Ah, Ran, MD; Kim, You, Na, MD; Kim, June-Gone, MD, PhD

doi: 10.1097/IAE.0000000000001674
Original Study

Purpose: To evaluate the predictors of refractory macular edema (ME) that develops despite multiple bevacizumab injections in patients with branch retinal vein occlusion (BRVO).

Methods: A total of 107 patients who followed at least 2 years were assigned to 2 groups: a refractory group (n = 56) and a responsive group (n = 51). Baseline characteristics, treatment response at 3 months, and fluorescein angiographic findings at 6 months were compared. Then we tried to identify factors associated with refractory ME development.

Results: Compared to the responsive group, the refractory group had older age, longer pre-treatment duration, and shorter occlusion distance from disk. At 3 months, the refractory group exhibited lower visual acuity, thicker central retinal thickness (CRT), and larger proportion of external limiting membrane (ELM) and outer plexiform layer disruption. After 6 months, proportion of unresolved vein occlusion, macular ischemia, number of microaneurysms, and non-perfusion areas were higher in the refractory group. Refractory ME was associated with pre-treatment duration ≥3 months, short occlusion distance from disk, thick CRT and ELM disruption at 3 months, and unresolved vein occlusion at 6 months.

Conclusion: If BRVO-ME patients exhibit the above-mentioned characteristics, they may have refractory ME, which should inform treatment decisions.

Refractory macular edema secondary to BRVO is associated with long pretreatment duration, thick CRT at 3 months, ELM disruption at 3 months and unresolved vein occlusion at 6 months after anti-VEGF treatment.

*Retina Center, Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea;

Seoul Shinsegae eye center, Uijeongbu, Korea; and

Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Reprint requests: June-Gone Kim, MD, PhD, Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; e-mail:

None of the authors has any financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.