Anti-vascular endothelial growth factor and choroidal thickness in retinal vein occlusion: A systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis assessed changes in subfoveal choroidal thickness (SFCT) and best-corrected visual acuity after intravitreal anti-VEGF therapy in adults with retinal vein occlusion. Across 23 studies involving 971 eyes, SFCT decreased significantly at each reported follow-up: the largest pooled reduction was at 6 months (mean difference 27.43 µm; 95% CI 14.00-40.85). Visual acuity improved across time points, with the greatest gains, approximately 0.25 logMAR, within 6 months. Changes in SFCT varied by RVO subtype and anti-VEGF agent.

Key findings

• Pooled SFCT reductions were significant at 1 month (MD 10.25 µm; 95% CI 6.31-14.19), 3 months (25.94 µm; 15.57-36.32), 6 months (27.43 µm; 14.00-40.85), and 12 months (12.05 µm; 3.02-21.09).
• Branch RVO showed early but transient choroidal thinning, whereas central RVO showed smaller, more sustained changes.
• Bevacizumab was associated with more consistent SFCT reduction than ranibizumab.
• BCVA improved at all reported time points, with the greatest gains (∼0.25 logMAR) within 6 months.

Why it matters

The findings suggest that choroidal thickness changes alongside visual improvement during anti-VEGF treatment for RVO-related macular edema. SFCT could therefore provide complementary information about treatment response, but the observed variation by RVO subtype and agent means it should not be interpreted as a uniform marker. The review highlights the need for standardized prospective assessment before its role is established.

What to keep in mind

The review reports that standardized prospective evaluation controlling for ocular biometry is needed; the pooled findings derive from 23 studies.