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Purpose: To evaluate long-term visual outcome of arteriovenous adventitial sheathotomy in BRVO-induced macular edema. Methods: The visual outcomes of 8 patients following vitrectomy with arteriovenous adventitial sheathotomy for BVO-induced macular edema (surgery group) were retrospectively evaluated. The three‐year post-operative visual acuity of the surgery group was compared with that of the conservatively managed controls. Results: All patients were followed for a minimum of 36 months. Mean BCVA (logMAR) in the surgery group changed from 1.10±0.34 to 1.19±0.70 and to 0.80±0.36 at 12 and 36 months, respectively (p=0.959 at 12 months, p=0.018 at 36 months). In the control group, visual acuity improved from 1.15±0.43 to 0.43±0.44 and to 0.43±0.39 at 12 and 36 months, respectively (p=0.015 at 12 months, at p=0.003 at 36 months). A strong trend toward better visual acuity at 12 months and final examination was observed for controls. (surgery vs. control group, p=0.052 at 12 months, p=0.066 at 36 months). Conclusions: Considering the favorable natural course of BVO and the unproven effect of reperfusion on macular edema, surgical efficacy of arteriovenous adventitial sheathotomy requires further evaluation.