To analyse the efficacy of subthreshold micropulse yellow laser photocoagulation (577 nm) in macular edema, secondary to branch retinal vein occlusion (BRVO) in a 43 – year old man with anti-VEGF (Vascular endothelial growth factor) resistance.


The patient with macular edema secondary to fresh inferior branch retinal vein occlusion was administered 6 injections of the anti-VEGF (Bevacizumab 1.25 mg in 0.05 ml) at two to three months interval. Although there was initial improvement, macular edema recurred at each instance. Recurrence was defined as a 30% increase in CMT (central macular thickness) after an initial decrease of CMT. At the end of oneyear, the intervention failed to achieve the desired outcomes. Subsequently, patient was subjected to subthreshold micropulse yellow laser photocoagulation (Iridex medical IQ577 – Iridex corporation, Mountain View, CA). The Mainster focal/grid Retina OCULAR lens was used. The power was kept at 380 mW, with exposure time and spot size of 200 ms and 200 μm respectively. Around 637 spots were given in the macular area. We documented the best corrected visual acuity (BCVA) on snellens’s chart and CMT (RS 3000, Nidek Co. Ltd.,with macular radial scans) every three months for one year and every 6 months subsequently.


The followed up for 30 months later. The baseline Snellen improved from 6/20 to 12/20 and remained stable. The CMT was reduced from 470 after last anti-VEGF injection to 84 -165 μm laser therapy. There was no evidence of retinal damage.


Subthreshold micropulse yellow laser appeared to be effective in the treatment of macular edema secondary to branch retinal vein occlusion in cases which are refractory to anti-VEGF treatment.



Matteo Forlini, Justyna Jędrychowska-Jamborska, Purva Date, Krzysztof Morawski, Bożena Romanowska – Dixon
Domus Nova Hospital
Email : matteoforlini@gmail.com
Cell Phone: +393395656062
Work Phone: +390544270385