Anatomical and Functional Outcomes of Anti-VEGF Therapy in Pachychoroid Neovasculopathy.

Background: Evaluation of real-life effectiveness of anti-VEGF therapy in patients diagnosed with pachychoroid neovasculopathy (PNV).

Methods: This retrospective analysis included central serous chorioretinopathy (CSC) patients who developed PNV and underwent anti-VEGF treatment. Individuals with concomitant retinal diseases were excluded. Key measures included best-corrected visual acuity (BCVA), spectral domain optical coherence tomography (SD-OCT) features (intra-/subretinal fluid, central retinal thickness (CRT), and choroidal thickness (CT)), and potential risk factors such as age, sex, and corticosteroid intake, baseline neovascularization area in fluorescein angiography and in OCT-angiography, and time from PNV diagnosis to treatment initiation.

Results: The study included 40 eyes of 40 patients (24 males, 16 females), with a mean follow-up period of 38.23±19.73 months and a mean number of anti-VEGF injections of 27.47±16.73. BCVA, CRT and CT improved significantly at the final visit compared to baseline (BCVA p=0.019, CRT p<0.001, CT p<0.001). 85% of eyes achieved a "completely dry" status on SD-OCT after a mean of 10.94±11.22 months and a mean of 8.88±9.17 injections. However, 82.4% of these eyes had a recurrence after a mean 3.32±4.82 months. There was no significant association of the evaluated risk factors with the treatment response. At the end of the observation period, there was no significant difference in BCVA between the "completely dry" group and the non-responders (p=0.765).

Conclusion: A majority of PNV patients exhibit anatomical and functional improvement following anti-VEGF therapy. However, the high rate of recurrences suggests a need for long-term treatment.