Outcome of navigated laser photocoagulation for persistent macular edema in branch retinal vein occlusion

To evaluate the clinical efficacy of navigated laser photocoagulation (Navilas®) for persistent macular edema (ME) secondary to branch retinal vein occlusion (BRVO), and to determine whether angiographic microaneurysm (MA) morphology, including clustered MAs, telangiectatic capillaries (TelCaps), and MAs within collateral vessels, is associated with successful discontinuation of anti-vascular endothelial growth factor (VEGF) therapy. This retrospective observational study included eyes with persistent BRVO-associated ME treated with Navilas® at Nagoya City University Hospital between June 2014 and February 2022 and followed for at least 3 months. Clinical data and multimodal imaging findings were retrospectively reviewed. Outcomes included changes in best-corrected visual acuity and central subfield thickness, changes in anti-VEGF injection frequency, and successful discontinuation of anti-VEGF therapy. Angiographic MA morphology was assessed using fluorescein angiography and indocyanine green angiography. Logistic regression analysis was performed to identify morphological predictors of treatment discontinuation. Best-corrected visual acuity remained stable throughout follow-up after Navilas®. Approximately 60% of eyes achieved successful discontinuation of anti-VEGF therapy. Discontinuation was achieved in 63% (5 out of 8) of eyes with TelCaps, 33% (2 out of 6) of eyes with MAs within collateral vessels, and 27% (3 out of 11) of eyes with clustered MAs. In eyes that required continued anti-VEGF therapy, the injection frequency was significantly reduced compared with the pretreatment period. Logistic regression analysis demonstrated that the presence of clustered MAs was significantly associated with failure to discontinue anti-VEGF therapy. Navilas® appears to be an effective adjunctive treatment for persistent BRVO-associated ME, maintaining visual function while reducing the burden of anti-VEGF therapy. The presence of clustered MAs may serve as a useful angiographic biomarker of suboptimal response to navigated laser treatment, potentially reflecting severe localized hyperpermeability and extensive capillary nonperfusion. Angiographic assessment of MA morphology may therefore help refine patient selection and guide individualized treatment strategies.