Eyes with refractory macular edema showed improvement of visual acuity and reduction of CSFT at three months when treated with combined IVTA and IVB.

Objective: To evaluate the changes in perifoveal capillary arcade in patients with retinal vein occlusion treated with intravitreal injections of anti-vascular endothelial growth factor for macular edema resulting from retinal vein occlusion with OCTA. Study Design: Quasi-experimental study.Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jul 2018 to Jul 2019. Methodology: Patients diagnosed as case of retinal vein occlusion underwent complete eye examination. Optical coherence tomography angiography (OCTA) was done in all the patients. Patients having macular edema were prescribed intravitreal anti-vascular endothelial growth factor inhibitors on monthly basis. OCTA was repeated at the third month. Results: In this study, 50 eyes were evaluated. After treatment patients having perifoveal capillary arcade of less than two quadrants increased from 47.7-68.8% (p<0.002) in the superficial capillary plexus and in deep capillary plexus this number increased from 50% to 88.6% (p<0.05). There was also a significant decrease in the number of macular cysts in the superficial and deep capillary plexus post treatment (p<0.05). Mean En face vascular density in superficial capillary plexus decreased in all the quadrants specially the foveal zone. Conclusion: Optical coherence tomography angiography (OCTA) showed a qualitative improvement in perifoveal arcade disruption and decrease in the number of cystic spaces. Quantitative analysis revealed a significant reduction in vessel density in all quadrants. It enables us to follow up patients with retinal vein occlusion and study the vascular arcade changes with time and treatment.