Risk characteristics of progressing retinal pigment epithelial atrophy during ranibizumab therapy for polypoidal choroidal vasculopathy

Abstract

Purpose: To investigate the risk characteristics of progressing retinal pigment epithelial (RPE) atrophy during ranibizumab therapy for polypoidal choroidal vasculopathy (PCV).

Methods: One hundred Japanese patients with unilateral symptomatic treatment-naïve PCV who received one intravitreal injection of 0.5 mg ranibizumab monthly for 3 months followed by an as-needed reinjection schedule were studied retrospectively. The area of RPE atrophy was measured in autofluorescence (AF) images of the macular region obtained by Heidelberg Retina Angiograph. Multiple regression analysis was performed using the characteristics to identify a significant association with progression of the area of RPE atrophy during ranibizumab therapy by univariate analyses. The data recorded were age, gender, visual acuity (VA), the area of RPE atrophy in the treated eye and fellow eye, greatest linear dimension (GLD), follow-up period, total number of injections, occurrence of a subretinal hemorrhage larger than two optic disc area, and a serous or a hemorrhagic pigment epithelial detachment larger than one optic disc area.

Results: The mean (± standard deviation) follow-up period was 17.5 ± 8.0 months. The mean number of ranibizumab injections was 7.4 ± 4.5. The mean baseline area of RPE atrophy in treated eyes was 1.22 ± 1.77 mm² and enlarged to 2.91±5.41 mm² at the last examination; the difference reached significance (P=0.001, paired t-test). The mean baseline area of RPE atrophy in the fellow eyes was 1.07 ± 1.83 mm² and remained 1.15±2.09 mm² at the last examination. Multiple regression analysis (P<0.001, r=0.624, R²=0.389) showed that a larger baseline area of RPE atrophy, worse baseline VA, and larger baseline GLD were risks for enlargement of the area of RPE atrophy. The enlarged area of RPE atrophy was correlated with decreased VA (P<0.001, r=0.429, R²=0.184).

Conclusions: The area of RPE atrophy progresses in eyes with PCV during ranibizumab therapy, which may be related to decreased VA. The baseline VA, GLD, and AF are associated with progression of RPE atrophy during ranibizumab therapy.