Recurrent polypoidal lesions after achieving inactive polypoidal choroidal vasculopathy following 1-year fixed-dosing aflibercept treatments

Purpose

Polypoidal choroidal vasculopathy (PCV) may have frequent recurrences after fluid resolution, but time to recurrence is unclear. This study explored time to first polypoidal recurrence after 1-year fixed-dosing aflibercept treatments.

Design

Retrospective cohort study.

Methods

Treatment-naïve PCV eyes treated between April 2015 to May 2019 were identified and included with criteria including: (1) received fixed-dosing 2 mg aflibercept in the first year, (2) became “inactive” (absence of both intraretinal and subretinal fluid on OCT) at post-treatment year-1 (PTY1) and managed as needed (PRN) thereafter, (3) FU ≥ 12 months after PTY1. Fundus photography, indocyanine green angiography (ICGA), and OCT graded to identify timing and risk factors for recurrence (defined as fluid on OCT).

Results

Of 37 study eyes [37 patients; median age was 64 years (IQR 59–69); median aflibercept injection number was 8 (IQR 8–8); median FU 38 months (IQR, 30–50 months)]; 18 eyes (49 %) had recurrence during FU. Fourteen (78 %) of 18 had recurrence within 12 months after PTY1 visit. Risk factors for recurrence included: incomplete polypoidal regression on post-treatment ICGA [P = .004, Hazard ratio (HR) = 4.4, 95 % confidence interval (CI) 1.6–11.9] and PED with internal heterogeneous reflectivity on post-treatment OCT (P = .04, HR = 2.7, 95 % CI 1.1–6.9).

Conclusions

Nearly half of inactive PCV eyes following 1-year fixed-dosing aflibercept treatments had recurrent polypoidal lesions. Eyes with high-risk features for recurrence, some of which can be detected with OCT without the need for ICGA, may warrant close monitoring.