Outcomes of treat and extend and cessation with anti-VEGF in a large cohort of patients with pachychoroid related neovasculopathy

Abstract

Purpose : Pachychoroid neovascularization (PNV) is a vision threatening sequelae of the pachychoroid disorder spectrum. Despite differences in the etiology of nAMD and PNV, treatment for PNV is inferred from nAMD treatment protocols. Our objective is to examine the long-term visual and morphological outcomes in a large series of patients with PNV who have undergone intravitreal anti-vascular endothelial growth factor (VEGF) therapy.

Methods : This is a retrospective, observational study of intravitreal anti-VEGF injections in 249 eyes of 237 patients with PNV at one retina center over 6 years. Patients with polypoidal choroid vasculopathy and those with less than 3 months of follow up were excluded. Baseline demographics, visual acuity (VA) and OCT characteristics were documented. The number of anti-VEGF injections, treatment duration, and success rate with cessation or the treat and extend protocol was assessed. The main outcomes measured were post treatment VA, recurrence on extension and recurrence on cessation.

Results : The mean patient age was 65.5 years old, with 43% being female. Follow up time averaged 1.91 years with a mean baseline VA of 61.0 ETDRS letters. 42 eyes had previous CSCR. PNV developed in 6.5% of the pachychoroid patient population. Time to best vision was 287 days (+11.6 ETDRS letters, p<0.05). By the end of the study period, the mean vision gain was 2.30 ETDRS letters (p=0.04). The mean number of anti-VEGF injections was 13.9, averaging 7.28 per year. Treat and extend was utilized in 77.9% of patients with a recurrence rate of 42.3%. Treatment cessation was trialed in 28.1% of eyes with 75.7% requiring no further treatment. Adjunct PDT occurred in 13.7% (n=34), with a mean vision improvement of 0.44 ETDRS letters vs 2.30 ETDRS letters in the anti-VEGF only group (p=0.6). Mean CST decreased by 78.2 microns (p<0.05) and mean choroidal thickness decreased by 35.4 microns (p<0.05).

Conclusions : Improvement in VA and anatomic features with anti-VEGF therapy was seen in our large cohort of PNV eyes. Visual gains and regression to baseline acuity occurred with treatment. The majority of patients who had treatment cessation after extension to 12 weeks required no further intervention. There was no significant difference in outcomes with anti-VEGF alone vs anti-VEGF and PDT. In summary, we report outcomes of a cohort of PNV patients who underwent treatment.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.