To evaluate the effects of macular ischemia and early treatment on the visual outcomes of patients with branch retinal vein occlusion (BRVO).

This study retrospectively reviewed the records of 42 patients who were treated with an intravitreal bevacizumab injection for BRVO, repeated 3 times at 6-week intervals and were whose data available for a follow-up period of at least 4 years. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) results before treatment and at 6, 12, 24, 36 and 48 months after the 3 serial injections, were measured. We assessed macular ischemia, time to the first treatment, and the relationship of these with BCVA.

Mean BCVA (log MAR) was significantly improved from 0.67 ± 0.43 at baseline to 0.30 ± 0.30 at 48 months ( p < 0.001). Four years after treatment, mean BCVA in the macular non-ischemic group was better than in the ischemic group, but this relationship did not hold for mean change in BCVA. There was a statistically significant ( p < 0.05) difference between the early (≤6 weeks) and late (>6 weeks) treatment groups in BCVA and mean change in BCVA after 48 months. There was statistically significant ( p < 0.05) difference between the early (≤6 weeks) and late (>6 weeks) treatment groups with macular ischemia in BCVA after 48 months.

In patients with BRVO, a significant visual improvement was maintained after intravitreal bevacizumab injections, despite the presence of macular ischemia. Early treatment (within 6 weeks) is more effective for maintaining and improving visual acuity. Similar results in the macular ischemia group confirmed the importance of early treatment.