How do polypoidal choroidal vasculopathy patients fare long term - A real world data

Abstract

The objective of this 5-year retrospective study of PCV eyes was to assess the clinical presentation and long-term real world visual and anatomical outcomes following therapy. Data included the baseline clinical and demographic profile, visual acuity and treatment details. Main outcome measured were anatomical and visual outcomes with treatment, treatment compliance and complications. Out the 45 PCV eyes (51 patients), 76.4% lesions occurred predominantly at the macula. Clinical presentations were variable though visible polyps (16.6%) and massive subretinal hemorrhage (17.7%) were less frequent. DLS with diffuse PEDs or thumb shaped PEDs were the most common finding in SD-OCT. OCTA was sensitive in identifying BVNs compared to ICGA but were poor in identifying polyps. Vision improvement was achieved in 42% eyes, while loss occurred in 26.6% eyes, with deterioration more in type 1 PCV. Baseline good vision, thicker CCT, smaller lesions and minimum recurrences at year 1 were risk factors associated with good outcomes. Mean number of injections was 18.7. 22% received primary PDT while 11% eyes received rescue PDT. Low fluence PDT was found to be as effective as standard fluence. Though not significant, PDT eyes required lesser injections than monotherapy. As an agent Aflibercept seemed to be better than Ranibizumab and was the most preferred switching agent (55% needed switch). Loading dose followed by PRN was the only feasible regimen with relatively reasonable compliance. Complications included RIP (11%) and 2 eyes requiring Vitrectomy for breakthrough vitreous hemorrhage. The superiority of aflibercept and the feasibility of a PRN approach is underlined in this study. In spite of suboptimal compliance this study reveals that nearly half the eyes demonstrated visual gains and anatomic stability.