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Clinical characteristics of super stable polypoidal choroidal vasculopathy after initial remission with anti-VEGF monotherapy

  • Retinal Disorders
  • Published:
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Abstract

Purpose

To define a “super stable” subset of polypoidal choroidal vasculopathy (PCV) patients that have a long period of remission following anti-vascular endothelial growth factor (VEGF) therapy.

Methods

Twenty-one eyes that showed no recurrence for over 18 months following anti-VEGF monotherapy were included in the “super stable PCV group” and compared with 37 eyes with recurring disease. Patient demographics, visual acuity, and imaging data from optical coherence tomography (OCT) and fluorescein angiography/indocyanine green angiography were compared between the two groups at baseline and at 3 months after treatment initiation.

Results

The super stable group maintained remission for a mean duration of 31.0 months following a mean of 4.1 anti-VEGF injections. The super stable group was younger at baseline (64.6 ± 8.8 vs. 71.4 ± 7.9 years, P < 0.05) with a higher ratio of females (52.4% vs. 24.3%, P < 0.05) compared with the control group. The super stable group had a higher percentage of eyes with a single polyp, as opposed to multiple polyps (66.7% vs. 32.4%, P < 0.05), and the diameter of the largest polyp was smaller (328.4 ± 98.2 vs. 398.3 ± 112.2 μm, P < 0.05). Baseline choroidal thickness was greater in the super stable group (357 ± 102.7 vs. 293.2 ± 94.6 μm, P < 0.05). At 3 months after treatment, OCT features including central retinal thickness, pigment epithelial detachment (PED) size, and presence of subretinal fluid showed superior response in the super stable group. The reduction in PED height was almost 3 times as large in the super stable group (− 250.1 ± 228.5 μm vs. − 84.4 ± 221.1 μm, P < 0.05). Binary logistic regression further showed that factors such as age, polyp configuration, PED diameter at 3 months, and change in PED height at 3 months were associated with super stable remission.

Conclusion

Identifying super stable PCV patients can prevent overtreatment and lessen treatment burden.

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Data availability

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Authors and Affiliations

  1. Department of Ophthalmology, Institute of Vision Research, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Seonghee Choi & Hyoung Jun Koh

  2. Department of Ophthalmology, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea

    Hae Min Kang

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  1. Seonghee Choi
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Correspondence to Hyoung Jun Koh.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval was granted by the Institutional Review Board (IRB) at Severance Hospital prior to study initiation. Patient consent was waived by the IRB committee.

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This manuscript was presented as an original paper at the 43rd Macular Society Meeting in February 2020. This material was also partly presented as a poster at the 2019 American Academy of Ophthalmology Annual Meeting in San Francisco.

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ESM 1

Initial indocyanine green angiography (ICGA) image from the same eye as in Fig. 3c. The optical coherence tomography angiography (OCT-A) image provided in Fig. 3c was taken 2 years after the patient was first diagnosed. The initial ICGA clearly demonstrates polypoidal macular neovascularization. In this patient, total pigment epithelial detachment (PED) regression was seen after 5 monthly aflibercept injections. The patient has not experienced recurrence of PED or exudative signs ever since. (PNG 901 kb)

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Choi, S., Kang, H.M. & Koh, H.J. Clinical characteristics of super stable polypoidal choroidal vasculopathy after initial remission with anti-VEGF monotherapy. Graefes Arch Clin Exp Ophthalmol 259, 837–846 (2021). https://doi.org/10.1007/s00417-020-04924-0

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