Baseline Optical Coherence Tomography Features and Visual Outcomes After Anti-vascular Endothelial Growth Factor Therapy for Retinal Vein Occlusion-Associated Macular Edema: A Prospective Observational Study

BackgroundMacular edema is a major cause of visual loss in retinal vein occlusion (RVO).Although anti-vascular endothelial growth factor (anti-VEGF) therapy reduces retinal thickening, visual recovery varies.The primary objective was to assess whether baseline optical coherence tomography (OCT) features were associated with visual acuity one month after the third anti-VEGF injection using a prespecified 6/18 threshold.Secondary objectives assessed demographic and clinical associations, while central macular thickness (CMT) reduction was evaluated exploratorily. MethodologyThis prospective observational study included 60 eyes of 60 patients with center-involving, RVO-associated macular edema treated between September 2022 and February 2024.Each eye received three intravitreal anti-VEGF injections, with assessment one month after each injection.A good outcome was defined as final visual acuity of 6/18 or better.Baseline OCT features included CMT, macular volume, hyperreflective foci, serous macular detachment, ellipsoid zone (EZ) and external limiting membrane (ELM) integrity, disorganization of the retinal inner layers (DRIL), foveal bulge, and ganglion cell layer (GCL) cystic spaces.Categorical variables were compared using Fisher's exact or Fisher-Freeman-Halton exact tests, and continuous variables using the independent-samples t-test. ResultsGood visual outcome occurred in 21 (35.0%)eyes.Younger age, branch RVO, and non-ischemic disease were associated with good outcomes (p = 0.001, p = 0.003, and p < 0.001, respectively).Baseline and final CMT were lower in the good-outcome group (both p < 0.001).Higher baseline macular volume, EZ disruption, DRIL, and ELM disruption were associated with poor outcomes, whereas foveal bulge was associated with good outcomes (all p < 0.001).CMT reduction >100 µm was not associated with visual outcome (p = 0.778). ConclusionsSeveral baseline OCT features were associated with final visual outcome, whereas CMT reduction was not.These findings are exploratory and do not establish independent predictive value or clinical utility.Larger studies with standardized treatment, multivariable adjustment, and external validation are needed.