5-year outcome of initial treatment with ranibizumab monotherapy for polypoidal choroidal vasculopathy with good visual acuity

Abstract

Purpose : To evaluate the 5-year outcome of intravitreal injections of ranibizumab (IVR) as initial treatment for polypoidal choroidal vasculopathy (PCV) with good visual acuity.

Methods :
We retrospectively reviewed twenty-three previously untreated patients with PCV with an initial decimal visual acuity (VA) of ≥0.7. Patients initially received 3 monthly IVR, followed by a pro re nata regimen for the first 3 years and continued anti-VEGF treatment of ranibizumab or aflibercept for subsequent 2 years. Supplemental half-fluence photodynamic therapy (PDT) or switching to the aflibercept were done in cases of poor or no response to IVR monotherapy

Results : Mean logarithm of the minimum angle of VA was 0.03 at baseline, 0.00 at month 12 (P = 0.086), 0.00 at month 24 (P = 0.026), 0.08 at month 36 (P = 0.71) and 0.09 at month 60 (P =0.23). Significant visual loss occurred in 3 eyes after 2 years. After loading treatments, retreatments were required in 21 of 23 eyes (91.3 %) during 5 years. Supplementary PDT and switching to aflibercept were required in 7 eyes (30.4 %) and in other 2 eyes (8.7%), respectively. In years 4-5, among 6 eyes without recurrence during the first 2 years, 4 eyes had recurrence. Of the remaining 17 eyes with recurrence, 15 eyes re-recurred and required additional anti-VEGF treatments. Dry macula obtained in 13 eyes (56.5 %) at month 60. Geographic atrophy was developed in 8 eyes (34.8 %) of which it appeared in 6 eyes after 3 years.

Conclusions : Most PCV patients with good VA maintained or improved VA for 5 years, but required repeated treatments. Ranibizumab monotherapy alone was insufficient to obtain stable conditions in approximately 40% of patients.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.