Evaluate what clinical gains can be achieved over conventional treatment with ranibizumab alone for central retinal vein occlusion (CRVO) when causal pathology is additionally successfully addressed with a laser-induced chorio-retinal anastomosis (L-CRA). 2-year extension of prospective, randomized, controlled clinical trial. 58 patients with macular edema secondary to CRVO randomized 1:1 to receive either an L-CRA (29) or sham procedure (29) at baseline and then monthly intravitreal ranibizumab 0.5mg Outcomes (best corrected visual acuity (BCVA), central subfield thickness (CST), injection requirements) were monitored in the monthly pro re nata (PRN) ranibizumab phase from months 7-48. Injection requirements for those with a functioning L-CRA (24 of 29) during the monthly PRN period from 7-24 months, were mean (95% confidence interval [CI]) of 2.18 [1.57, 2.78] injections compared to 7.07 [6.08, 8.06] (p<0.0001) for control (ranibizumab alone). These decreased further over the next 2 years to 0.29 (0.14, 0.61) compared to 2.20 (1.68, 2.88) (p<0.001) for the third year and 0.25 (0.11, 0.56) and 1.84 (1.34, 2.54) for the fourth year (p<0.001). Mean BCVA was statistically different at all follow-up time points from month 7 through to month 48 for the group with the functioning L-CRA compared to the control monotherapy group. This improved to 14.06 letters at month 48 (p=0.009). There was no difference in CST between any of the groups over the 48 months of follow-up. For CRVO patients, addressing causal pathology in addition to conventional therapy, improves BCVA and reduces injection requirements.