Vanishing pachy-choroid in pachychoroid neovasculopathy under long-term anti-vascular endothelial growth factor therapy

Benedikt Schworm, Nikolaus Luft, Leonie F Keidel, Thomas C Kreutzer, Tina R Herold, Siegfried G Priglinger, Jakob Siedlecki, Benedikt Schworm, Nikolaus Luft, Leonie F Keidel, Thomas C Kreutzer, Tina R Herold, Siegfried G Priglinger, Jakob Siedlecki

Abstract

Background: To investigate the diagnostic value of choroidal thickness in the definition of pachychoroid neovasculopathy (PNV), especially in eyes treated with anti-vascular endothelial growth factor (VEGF) therapy.

Methods: Twenty-two consecutive eyes of 11 patients with uni- or bilateral PNV were analyzed. Anti-VEGF treatment was correlated with changes in choroidal thickness on enhanced depth imaging optical coherence tomography.

Results: There were 14 eyes with PNV and 8 non-neovascular partner eyes. Mean age was 64.2 ± 4.0 (range: 60-72), total follow-up was 1.8 ± 0.4 (1-2) years. In PNV eyes, choroidal thickness at baseline was 400 ± 58 (269-485) μm. After two years and 13 anti-VEGF injections on average, a mean reduction of - 39 ± 10 (- 26 to - 56) % to final 241 ± 52 (162-327) μm was observed (p < 0.0001). Meanwhile, choroidal thickness in the partner eyes remained stable (p > 0.13 for all comparisons). A significant correlation of choroidal thinning and anti-VEGF injection rate was observed at year one (r = - 0.79; R2 = 0.63; p = 0.00073) and two (r = - 0.69; R2 = 0.48; p = 0.019). While 85.7% of PNV eyes exceeded a pachychoroid threshold of ≥350 μm at baseline, this figure dropped to 21.4% at year one and 0% at year two.

Conclusion: In PNV, choroidal thickness significantly decreases with anti-VEGF therapy, resembling a "vanishing pachy-choroid", and thus does not represent a valid long-term diagnostic criterium, especially when differentiating PNV from nAMD.

Keywords: Central serous chorioretinopathy; Choroidal neovascularization; Optical coherence tomography; Pachychoroid; Pachychoroid neovasculopathy; Ranibizumab; Vascular endothelial growth factor.

Conflict of interest statement

No author reports any financial interest relevant to this study.

Benedikt Schworm received previous speaker fees and travel expenses from Novartis Pharma GmbH and Topcon Corporation. Nikolaus Luft received income from honoraria as a lecturer from Alcon Laboratories Inc., NIDEK Co. Ltd. and CenterVue SpA. Leonie F Keidel received income from honoraria as a lecturer from Recordati Pharma GmbH. Thomas C Kreutzer received previous speaker fees from Alcon Pharma GmbH. Thomas C Kreutzer received personal consultation fees from Novartis Pharma GmbH and Bayer AG. Thomas C Kreutzer received travel reimbursement from D.O.R.C. (International) B.V. Karsten Kortuem received previous speaker fees and/or travel expenses from Novartis Pharma GmbH, Bayer AG, and Alcon Pharma GmbH. Karsten Kortüm received personal consultation fees from Big Picture Medical. Karsten Kortüm received travel expenses from Pharm-Allergan GmbH and Heidelberg Engineering GmbH. Armin Wolf received previous speaker fees and research funds from Novartis Pharma GmbH, Oertli AG, Bayer AG, Pharm-Allergan GmbH and Alimera Sciences Ophthalmologie GmbH. Tina Rike Herold received income from honoraria as a lecturer from Novartis GmbH, Bayer AG and Pharm-Allergan GmbH. Siegfried Priglinger received previous speaker fees and/or travel expenses from Novartis Pharma GmbH, Oertli AG, Bayer AG, Alcon Pharma GmbH and Pharm-Allergan GmbH. Jakob Siedlecki received previous speaker honoraria, personal consultation honoraria and travel expenses from Novartis Pharma GmbH, Bayer AG, Roche AG, Carl Zeiss Meditec AG, Oculentis OSD Medical GmbH and Allergan GmbH.

Figures

Fig. 1
Fig. 1
Changes in subfoveal choroidal thickness (SFCT) during follow-up. In PNV eyes, SFCT significantly decreased by 39% from baseline to end of follow-up, In partner eyes, SFCT remained unchanged during follow-up
Fig. 2
Fig. 2
Correlation of subfoveal choroidal thinning and amount of anti-VEGF injections in the first year. A significant strong negative correlation was found (r = − 0.79; R2 = 0.63; p = .00073; Fig. 1). In year two, this correlation was maintained (r = − 0.69; R2 = 0.48; p = .019)
Fig. 3
Fig. 3
Percentage of PNV eyes fulfilling pachychoroid disease diagnostic thresholds at baseline, year one and two. At baseline, 12 out of the 14 PNV eyes (85.7%) exceeded a pachychoroid threshold of ≥350 μm. After anti-VEGF treatment, at year one, this figure dropped to 3 eyes (21.4%), and at year two, no eye fulfilled the threshold. Considering a pachychoroid threshold of ≥300 μm, 13 out of the 14 PNV eyes (92.9%) exceeded this value at baseline. After anti-VEGF treatment, this figure dropped to 4 eyes (28.5%) at year one, and one eye (9.1%) at year two

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