Anti-vascular endothelial growth factor and choroidal thickness in retinal vein occlusion: A systematic review and meta-analysis.

Anti-vascular endothelial growth factor (anti-VEGF) therapy is the standard of care for reetinsl vein occlusion (RVO)-related macular edema, yet its influence on subfoveal choroidal thickness (SFCT,) a potential adjunctive biomarker of disease activity and treatment response, remains uncertain. We evaluated studies that quantify pooled changes in SFCT and best-corrected visual acuity (BCVA) following intravitreal anti-VEGF therapy in adults with RVO. Twenty-three studies (971 eyes) met inclusion criteria. Anti-VEGF therapy significantly reduced SFCT at 1 month (MD 10.25 µm; 95% CI 6.31-14.19), 3 months (25.94 µm; 15.57-36.32), 6 months (27.43 µm; 14.00-40.85), and 12 months (12.05 µm; 3.02-21.09). Branch RVO demonstrated early but transient thinning, while central RVO showed smaller yet more sustained changes. Bevacizumab yielded more consistent SFCT reduction than ranibizumab. BCVA improved across all time points, with the greatest gains (∼0.25 logMAR) within 6 months. Intravitreal anti-VEGF therapy induces moderate, early choroidal thinning and concurrent visual improvement in RVO. SFCT may represent an adjunct biomarker of response, warranting standardized prospective evaluation controlling for ocular biometry.