Effect of anti-VEGF therapy on wide-field retinal and choroidal thickness in macular edema secondary to retinal vein occlusion

To investigate the effect of anti-VEGF therapy on wide-field retinal and choroidal thickness in patients with macular edema secondary to RVO, and to identify how these effects vary based on clinical characteristics such as occlusion location and patient sex. Retrospective observational study. Thirty-eight patients (38 eyes) with RVO treated at Keio University Hospital (26 males, 12 females; mean age, 67.7 ± 8.5 years). Seventeen fellow eyes without injection served as internal controls. We analyzed 38 eyes with RVO who received intravitreal injections of aflibercept ( n = 31) or ranibizumab ( n = 7). Wide-field optical coherence tomography (OCT) was performed at baseline (within 7 days before the injection) and at the follow-up visit (30 ± 14 days after the injection). Changes in retinal and choroidal thickness were analyzed across nine predefined regions: a central 5-mm subfield (C0) and eight surrounding peripheral sectors: temporal (L1), superior-temporal (L2), superior (L3), superior-nasal (L4), nasal (L5), inferior-nasal (L6), inferior (L7), and inferior-temporal (L8). Statistical analysis was performed using the Wilcoxon signed-rank test and Bonferroni correction for nine regions. Changes in regional retinal and choroidal thickness Post-injection, retinal thickness significantly decreased in all regions except L4 and L6 ( p < 0.0056). Choroidal thickness showed a significant reduction in L2, L5, and L8 ( p < 0.0056). Subgroup analyses revealed no significant changes in choroidal thickness in either the superior RVO group (n = 9) or the inferior RVO group (n = 17). A clear sex-based difference was also observed: male patients ( n = 26) exhibited choroidal thinning in L4, L5, L6, and L8 ( p < 0.0056), whereas female patients ( n = 12) showed no significant changes in any region. Anti-VEGF therapy reduced retinal and choroidal thickness in specific regions in eyes with RVO. No significant differences were observed between eyes with superior and inferior occlusions. In male patients, significant thinning was observed in multiple peripheral regions, whereas no significant changes were noted in female patients. These findings suggest that the choroidal response to anti-VEGF therapy is complex and warrants further investigation.