After complete polyp regression in PCV, half of eyes recur on as-needed aflibercept

Design

Prospective multicentre cohort

Population

81 treatment-naive eyes with PCV in Thailand; 26 regressed eyes analysed on as-needed dosing

Primary outcome

Fluid-free interval after complete polypoidal regression

Effect

Recurrence 50% (30 to 70%) within 2 years; fluid-free 53% at week 84

This prospective study at four Thai university hospitals gave 81 treatment-naive eyes with polypoidal choroidal vasculopathy three monthly aflibercept 2 mg injections, then three more if polyps persisted. Eyes with complete polypoidal regression switched to as-needed treatment with monthly then bimonthly review over two years.

Complete regression occurred in 32 eyes (40%). Of 26 regressed eyes analysed, 13 (50%) recurred within two years; fluid-free probability was 53% at week 84. At recurrence, the median change was −3.5 letters; 3 of 14 (21%) lost 10 or more letters and 5 (36%) had new haemorrhage. In exploratory analysis, baseline massive subretinal haemorrhage was associated with lower recurrence (HR 0.18), and leakage without haemorrhage possibly with higher (HR 2.65, not significant).

Polypoidal choroidal vasculopathy is common in Asian populations, including India, and complete regression is often taken as a signal to stop treating. This study shows that for half of eyes it is not durable, and some recurrences bring haemorrhage and lasting vision loss. Deferring treatment is reasonable for some, but only with close monitoring. The regressed cohort is small.

• Do not treat complete polypoidal regression as cure; half of eyes recurred within two years.
• If you switch to as-needed treatment, keep monthly OCT review for at least the first year.
• Consider treat-and-extend rather than as-needed for eyes with leakage but no subretinal haemorrhage at baseline.
• Warn patients that a recurrence can bring new haemorrhage and ask them to report sudden vision change.

Why it matters

It challenges the practice of stopping injections once polyps regress.

Don't overread it

Only 26 regressed eyes; the baseline predictors of recurrence are post hoc and exploratory.

The statistics, in plain English

A recurrence rate of 50% with a 95% interval of 30 to 70% shows how uncertain small numbers are. The hazard ratio of 0.18 for massive haemorrhage came from an exploratory analysis and needs confirmation.

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