Temporal Dynamics of Polyp Regression and Retreatment Burden in As-Needed VEGF Inhibitor Therapy: A 24-Month Study.

Purpose: This study aimed to evaluate how the temporal dynamics of polyp regression influence 24-month outcomes in eyes with polypoidal choroidal vasculopathy (PCV) treated with as-needed vascular endothelial growth factor (VEGF) inhibitors.

Methods

Sixty-three eyes of 63 patients were included. All patients initially received three monthly intravitreal injections of either aflibercept (2 mg) or brolucizumab, followed by as-needed treatment for 24 months. The selection of a VEGF inhibitor depends on time. Indocyanine green angiography (ICGA) was performed at baseline, 3 months, and 12 months in all patients.

Results

Among the 63 eyes, complete regression was observed in 39 eyes (61.9%) at 3 months. Of these 39 eyes, 29 eyes (46.0%) maintained complete regression at 12 months. Among the 24 eyes that did not show complete regression at 3 months, 5 eyes (20.8%) achieved complete regression at 12 months. Visual acuity improved over 24 months regardless of the timing of regression. Early regression at 3 months was associated with fewer additional injections during the first year. In contrast, regression at 12 months-rather than at 3 months-was more strongly associated with fewer additional injections during the second year.

Conclusions

The most recent status of the polypoidal lesion was associated with the number of additional injections during the corresponding 12-month period, suggesting that ICGA-based assessment may be important for predicting treatment responsiveness.