TOPLINE

Among eyes with polypoidal choroidal vasculopathy (PCV) — a subtype of age-related macular degeneration — that achieved complete regression after receiving either three or six monthly injections of aflibercept, half stayed fluid-free for up to 2 years with an as-needed treatment approach, while the other half experienced recurrence. Eyes with substantial bleeding under the retina at baseline were less likely to have recurrence, while those with a larger residual "double-layer sign" on retinal imaging showed a trend toward a higher risk for recurrence, although this association was not statistically robust.

METHODOLOGY

• Researchers conducted a prospective cohort study to evaluate how long eyes with PCV could stay free of recurrence after achieving regression with aflibercept and whether an as-needed treatment approach preserved vision outcomes.
• They enrolled 81 participants with PCV who had not previously received treatment (mean age, 64 years; 54% women) and received three monthly injections of 2 mg aflibercept.
• At week 12, eyes that had achieved regression switched to as-needed treatment, with monthly monitoring in the first year and every-other-month monitoring in the second year. Eyes that had not yet regressed received three more monthly injections; if they achieved regression by week 24, they followed the same as-needed schedule. Eyes that had not achieved regression by week 24 were switched to a treat-and-extend regimen.
• At every visit, including baseline, patients underwent visual acuity testing, color photography of the retina, and optical coherence tomography (OCT) imaging to check for fluid. They also had two dye-based imaging tests — fluorescein angiography and indocyanine green angiography (ICGA) — at baseline and at weeks 12, 24, 48, and 96 to look for abnormal blood vessels.
• The study's primary goal was to measure how long the retina stayed free of fluid on OCT scans after complete regression was confirmed by ICGA imaging following the initial aflibercept injections.

TAKEAWAY

• Of the 32 eyes (40%) that achieved regression by week 24, 26 completed the week 96 follow-up, and half of those (n = 13) went on to develop recurrence.
• Analysis of the 32 eyes with regression showed a two-phase pattern: The probability of staying fluid-free dropped to 57% within 24 weeks of regression and then plateaued. By 84 weeks after regression, 53% of the eyes remained fluid-free. The risk for recurrence was highest in the 6 months immediately after regression and tapered off thereafter.
• Among the 14 eyes with recurrence (13 that completed follow-up and one that developed recurrence before being lost to follow-up), vision worsened by a median of 3.5 letters, three eyes lost two or more lines of vision, and five eyes developed new bleeding under the macula.
• Significant bleeding under the retina at baseline was linked to a lower risk for recurrence (hazard ratio, 0.18; P = .01). Eyes with a larger residual double-layer sign on OCT at the visit just before treatment was deferred tended to have a higher risk for recurrence; however, this association was not statistically significant.

IN PRACTICE

"[E]yes achieving complete polypoidal regression within the first 6 months of aflibercept therapy might be considered for treatment deferral with close OCT monitoring when they exhibit a relatively small residual double-layer sign on posttreatment OCT or initially present with a baseline massive subretinal hemorrhage, as these features were associated with a lower risk of recurrence," the researchers reported.

SOURCE

The study was led by Voraporn Chaikitmongkol, MD, of the Department of Ophthalmology, Faculty of Medicine, Chiang Mai University in Chiang Mai, Thailand. It was published online on September 17 in JAMA Ophthalmology.

LIMITATIONS

The study had a relatively small number of participants, which may have limited the precision of its findings. It also relied on ICGA — the gold-standard imaging test for confirming regression — but this technique is not routinely available in most clinics. Since the study only tested a specific dose of aflibercept, it's unclear whether the results apply to other anti-vascular endothelial growth factor agents.

DISCLOSURES

This study was supported by Bayer, the Faculty of Medicine at Chiang Mai University, the Faculty of Medicine at Prince of Songkla University, and other sources. Several authors reported receiving research grants, personal fees, and nonfinancial support from pharmaceutical companies, including Bayer. One author, who serves as the journal's editor-in-chief, was not involved in the manuscript's review or acceptance.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.