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Jeehyun Kim, Yu Cheol Kim, Kwang-Soo Kim; Consideration of the benefit of additional intravitreal anti-vascular endothelial growth factor injection in polypoidal choroidal vasculopathy patients with chronic subfoveal subretinal fluid. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3350. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To see the benefit of additional intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection in polypoidal choroidal vasculopathy (PCV) patients with no intraretinal edema at macular area, but with chronic and persisting subfoveal subretinal fluid (SRF) in spite of continuous anti-VEGF injections.
Study eyes were identified from a consecutive series of 195 PCV patients being treated with intravitreal anti-VEGF therapy by pro re nata protocol for over 1 year of regular follow-up. The clinical histories of 25 eyes of 25 patients with PCV with chronic subfoveal SRF (thickness less than 150 μm) despite appropriate anti-VEGF therapy for over 6 months and without any intraretinal edema at macular area were reviewed. Demographic factors, baseline and final visual acuity, type and number of anti-VEGF injection, baseline and final thickness of subfoveal choroid and foveal sensory retina, and duration of persistent subfoveal SRF were analyzed.
The mean age of patients was 72.3 years. The mean duration of treatment was 45.7 months and the mean duration of persistent subfoveal fluid was 17.3 months. During subfoveal fluid persist, mean best corrected visual acuity of with or without anti-VEGF injection was compared and showed no diffenrence in 20 eyes. Thicker the sensory retina correlated with better final visual acuity (p=0.002). The mean number of injections was 5.2. The thickness of the sensory retina of fovea and subfoveal choroid was not correlated with the number of injection, but both showed significant decrease compared to the thickness before the injection treatment.
In eyes with PCV associated with chronic persistent subfoveal SRF despite continuous intravitreal anti-VEGF injection, if the fluid is not thick enough to effect on the visual acuity, the existence may not be the problem and the response to the anti-VEGF injection can be poor. The complication of anti-VEGF injection should be considered and our hypothesis is that the injection may not be much beneficial in those eyes. The prognosis of final visual acuity maybe affected by the final thickness of sensory retina of fovea.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Table 1: Patient Demographics and Clinical Characteristics
Figure 1: The Relationship Between the Final Thickness of Foveal Sensory Retina and the Final Snellen Acuity
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