Navigated laser and aflibercept versus aflibercept monotherapy in treatment-naïve branch retinal vein occlusion: A 12-month randomized trial

Katrine Hartmund Frederiksen, Jesper Pindbo Vestergaard, Frederik Nørregaard Pedersen, Anna Stage Vergmann, Torben Lykke Sørensen, Caroline Schmidt Laugesen, Ryo Kawasaki, Tunde Peto, Jakob Grauslund

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PURPOSE: Angiostatic agents have proven effective in the treatment of macular oedema in patients with branch retinal vein occlusion (BRVO). However, treatment is inconvenient and expensive, and novel treatment regimens are warranted. We aimed to evaluate if combination treatment of navigated central retinal laser and aflibercept lowered the treatment burden in these patients.

METHODS: Treatment-naïve patients with BRVO and macular oedema were included at two centres and randomized 1:1 to three monthly injections of 2.0 mg aflibercept with (Group A) or without (Group B) navigated central laser, followed by aflibercept as needed from month 4 through 12. Re-treatment need was evaluated, and secondary endpoints included functional and anatomical outcomes and safety evaluated by retinal microperimetry.

RESULTS: We evaluated 41 eyes of 41 patients with a mean age of 69.6 years. Baseline median best-corrected visual acuity (BCVA) was 70.0 letters, and median central retinal thickness (CRT) was 502 μm with no difference between Groups A (n = 21) and B (n = 20). Percentage of patients needing re-treatment after month three was 71% and 80% (p = 0.72). At month 12, groups did not differ in number of injections after loading (1 versus 2, p = 0.43), change in BCVA (+12.8 versus +15.1 letters, p = 0.48), CRT (-195 versus -181 μm, p = 0.82), or retinal sensitivity (+3.3 versus +4.1 dB, p = 0.67).

CONCLUSION: In treatment-naïve BRVO patients, addition of navigated central laser to aflibercept did not lower treatment burden or affect functional or anatomical outcomes. A low number of intravitreal injections were needed for successful outcome in both treatment arms.

Original languageEnglish
JournalActa Ophthalmologica
Issue number7
Pages (from-to)e1503-e1509
Publication statusPublished - Nov 2022


  • Aged
  • Angiogenesis Inhibitors
  • Humans
  • Intravitreal Injections
  • Lasers
  • Macular Edema/diagnosis
  • Receptors, Vascular Endothelial Growth Factor
  • Recombinant Fusion Proteins/therapeutic use
  • Retinal Vein Occlusion/diagnosis
  • Treatment Outcome
  • Vascular Endothelial Growth Factor A
  • Visual Acuity


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