Anti-vascular endothelial growth factor monotherapy for polypoidal choroidal vasculopathy with polyps resembling grape clusters

The objective of this study was to investigate the 2-year outcomes of treatment with anti-vascular endothelial growth factor (VEGF) in patients with polypoidal choroidal vasculopathy (PCV) with polyps resembling grape clusters. Twenty eyes in 20 patients were included. All patients initially received three consecutive anti-VEGF injections, followed by an as-needed re-injection schedule. Patients were followed regularly at 1- to 3-month intervals. The primary outcome was change in best-corrected visual acuity (BCVA). The mean number of injections administered over the course of 24 months was 12.50 +/- 2.77 (range, 9-18). The logarithm of the minimum angle of resolution (logMAR) BCVA improved from 0.61 +/- 0.28 to 0.42 +/- 0.27 at 12 months (P = 0.015), and 0.44 +/- 0.31 at 24 months (P = 0.056). At 24 months, BCVA had improved in 6 (30.0 %) eyes by 0.3 logMAR or more, was stable in 11 (55.0 %) eyes, and had decreased in 3 (15.0 %) eyes. Complete absorption of fluid was achieved with anti-VEGF treatment in 18 (90 %) eyes at least once during the 2-year follow-up period, and 10 (50 %) eyes revealed a dry macula at 24 months. Two eyes (10.0 %) received rescue photodynamic therapy because subfoveal fluid persisted despite six and seven consecutive anti-VEGF injections. Of 18 eyes treated only with anti-VEGF agents, 3 (16.7 %) revealed partial resolution of the polypoidal lesions at 24 months. A treatment regimen with anti-VEGF effectively improved or maintained visual acuity over a 24-month period in patients with PCV with clusters of grape-like polyps, and required frequent injections, comparable to typical choroidal neovascularization in age-related macular degeneration.