Polypoidal choroidal vasculopathy: complete regression still needs close monitoring

Design

Prospective multicentre cohort, 4 Thai university hospitals

Population

81 treatment-naive eyes with PCV on aflibercept 2 mg; 26 followed after complete regression

Primary outcome

Fluid-free interval after regression on as-needed treatment

Effect

50% recurred within 2 years (95% CI 30% to 70%); fluid-free 53% at week 84

Complete regression of polyps is a treatment goal in polypoidal choroidal vasculopathy, which is common in Asian populations, but what to do afterwards is debated. A prospective study at four Thai university hospitals treated 81 treatment-naive eyes with monthly aflibercept 2 mg — three doses, or six if polyps persisted — then switched eyes with complete regression to as-needed treatment with monthly review in year one and two-monthly review in year two.

Forty per cent achieved regression. Of the 26 eyes followed after regression, half recurred within two years, and the probability of remaining fluid-free was about 53% at 84 weeks. Among eyes that recurred, about one in five lost 10 or more letters and over a third developed new haemorrhage. In an exploratory analysis, eyes that had presented with massive subretinal haemorrhage were less likely to recur, while leakage without haemorrhage may have been more likely to.

The practical message is that regression is not a reason to stretch follow-up or discharge. If an as-needed approach is used after regression, it needs regular OCT surveillance, and for some eyes continued treat-and-extend dosing may be safer. The numbers are small and the confidence intervals wide.

• Continue regular OCT review after complete polyp regression; half of eyes recurred within two years.
• Consider treat-and-extend rather than as-needed dosing for eyes where a recurrence would threaten good vision.
• Warn patients that recurrence can bring sudden haemorrhage and ask them to report new blurring or distortion promptly.
• Use ICGA where available to confirm regression rather than relying on OCT alone.
• Factor follow-up feasibility into the regimen choice; as-needed treatment only works with reliable review.

Why it matters

Regression is often treated as an end point, but the disease frequently returns, sometimes with bleeding.

Don't overread it

With 26 eyes after regression, the recurrence rate is imprecise, and the predictors of recurrence were post hoc.

The statistics, in plain English

Half recurred, but the 95% confidence interval runs from 30% to 70% — the true figure could be anywhere in that range. The haemorrhage-related hazard ratios come from exploratory analyses and need confirmation.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.