Abstract Purpose: To evaluate the impact of hyperreflective foci (HRF) distribution and external limiting membrane (ELM) integrity on visual prognosis in patients with retinal vein occlusion (RVO) treated with intravitreal bevacizumab. Methods: This observational, noncomparative study included 77 RVO patients (43 with branch RVO BRVO, 34 with central RVO CRVO). All patients received three intravitreal bevacizumab 0.05 mL injections given at a monthly interval. Swept-source optical coherence tomography was used to assess HRF distribution in the inner and outer retinal layers, as well as ELM integrity. Best-corrected visual acuity (BCVA) was measured at baseline, day 30, and day 90. Good visual prognosis was defined as BCVA better than 6/18 (LogMAR ≤0.48), and poor prognosis as BCVA worse than 6/18 (LogMAR >0.48). Statistical analyses included the Wilcoxon Signed-Rank, Mann–Whitney U, and logistic regression. Results: Both BRVO and CRVO groups showed significant BCVA improvements, though BRVO patients achieved greater visual gains. At day 90, BRVO eyes improved by 50.45% compared to 36.35% in CRVO. HRF in the outer retina was more frequent in CRVO (88.2%), while inner retinal HRF predominated in BRVO (44.2%). ELM disruption was present in 44.1% of CRVO and 44.2% of BRVO eyes and was consistently associated with poorer visual outcomes ( P < 0.05). Conclusion: HRF localisation and ELM integrity are strong predictors of visual prognosis in RVO patients treated with bevacizumab. Inner retinal HRF and intact ELM are associated with better recovery. Although HRF quantification and optical coherence tomography (OCT) angiography were not performed, these results highlight the clinical value of routine structural OCT biomarkers in tailoring management strategies.
Saha et al. (2026) studied this question.