Visual Outcomes After Macular Edema Treatment Worse With Glaucoma

Branch Retinal Vein Occlusion (BRVO)
A study shows the effect glaucoma has on eyes with macular edema associated with branch retinal vein occlusion undergoing anti-VEGF treatment.

The therapeutic response of anti-vascular endothelial growth factor (anti-VEGF) agents in branch retinal vein occlusion macular edema (BRVO-ME) is negatively impacted by the presence of glaucoma, according to research published in Clinical Ophthalmology. The study shows inferior visual acuity in patients with glaucoma who underwent the treatment compared with those without glaucoma.

Researchers recruited patients who received anti-VEGF agents for BRVO-ME treatment at Mie University Hospital, Mie, Japan, from 2013 to 2017. The team evaluated central retinal thickness (CRT) and best-corrected visual acuity (BCVA) at 3 months after a single injection of anti-VEGF agents.

The team compared a BRVO-ME alone group (27 eyes of 27 patients, mean age of 69.8±11.1 years) and a BRVO-ME with glaucoma group (30 eyes of 30 patients, mean age 72.0±10.9 years, ). The BRVO-ME alone group had a baseline BCVA of 0.42±0.32 logMAR, CRT of 514.2±117.3 µm, and intraocular pressure (IOP) of 12.7 mm Hg. The BRVO-ME with glaucoma group had a baseline BCVA of 0.57±0.33 logMAR units, CRT of 533.4±171.4 µm, and IOP of 15.8 mm Hg. 

The researchers found that CRT was significantly reduced relative to baseline in both groups at 1 month (321.1±114.6 μm in BRVO-ME alone and 347.8±134.7 μm in BRVO-ME glaucoma; P <.01 for both) and 3 months after injection (360.4±159.5 and 352.4±151.9 μm, respectively; P <.01 for both), with no difference in the degree of CRT reduction between the groups. 

The researchers found that BCVA improved significantly relative to baseline in both groups at 1 month (0.27±0.26 logMAR units in BRVO-ME alone and 0.34±0.42 logMAR units in BRVO-ME glaucoma; P <.01 for both) and 3 months after injection (360.4±159.5 and 352.4±151.9 μm, respectively; P <.01), with significantly more improvement in the BRVO-ME alone group than in the BRVO-ME glaucoma group at 3 months (P =.02).

“Our findings showed that anti-VEGF agents were effective in the eyes of BRVO-ME patients with or without glaucoma. However, because earlier reductions in BCVA were observed in BRVO-ME with glaucoma compared with those without glaucoma, a glaucomatous background may affect the maintenance of visual function after anti-VEGF treatment,” researchers report.

The primary limitations of the study were the relatively small number of patients and retrospective, single-center design.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  


Asami S, Sugimoto M, Tsukitome H, et al. Anti-vascular endothelial growth factor treatment for macular edema in eyes with branch retinal vein occlusion with vs without glaucoma – does glaucoma affect visual outcome in eyes with BRVO-ME after anti-VEGF injections?. Clin Ophthalmol. 2022;16:2275-2283. doi:10.2147/OPTH.S356727