Clinical characteristics of super stable polypoidal choroidal vasculopathy after initial remission with anti-VEGF monotherapy

Purpose To define a "super stable" subset of polypoidal choroidal vasculopathy (PCV) patients that have a long period of remission following anti-vascular endothelial growth factor (VEGF) therapy. Methods Twenty-one eyes that showed no recurrence for over 18 months following anti-VEGF monotherapy were included in the "super stable PCV group" and compared with 37 eyes with recurring disease. Patient demographics, visual acuity, and imaging data from optical coherence tomography (OCT) and fluorescein angiography/indocyanine green angiography were compared between the two groups at baseline and at 3 months after treatment initiation. Results The super stable group maintained remission for a mean duration of 31.0 months following a mean of 4.1 anti-VEGF injections. The super stable group was younger at baseline (64.6 +/- 8.8 vs. 71.4 +/- 7.9 years, P < 0.05) with a higher ratio of females (52.4% vs. 24.3%, P < 0.05) compared with the control group. The super stable group had a higher percentage of eyes with a single polyp, as opposed to multiple polyps (66.7% vs. 32.4%, P < 0.05), and the diameter of the largest polyp was smaller (328.4 +/- 98.2 vs. 398.3 +/- 112.2 mu m, P < 0.05). Baseline choroidal thickness was greater in the super stable group (357 +/- 102.7 vs. 293.2 +/- 94.6 mu m, P < 0.05). At 3 months after treatment, OCT features including central retinal thickness, pigment epithelial detachment (PED) size, and presence of subretinal fluid showed superior response in the super stable group. The reduction in PED height was almost 3 times as large in the super stable group (- 250.1 +/- 228.5 mu m vs. - 84.4 +/- 221.1 mu m, P < 0.05). Binary logistic regression further showed that factors such as age, polyp configuration, PED diameter at 3 months, and change in PED height at 3 months were associated with super stable remission. Conclusion Identifying super stable PCV patients can prevent overtreatment and lessen treatment burden.