Results of 2 years of treatment with as-needed ranibizumab reinjection for polypoidal choroidal vasculopathy

Taiichi Hikichi, Makoto Higuchi, Takuro Matsushita, Shoko Kosaka, Reiko Matsushita, Kimitaka Takami, Hideo Ohtsuka, Hirokuni Kitamei, Shoko Shioya, Taiichi Hikichi, Makoto Higuchi, Takuro Matsushita, Shoko Kosaka, Reiko Matsushita, Kimitaka Takami, Hideo Ohtsuka, Hirokuni Kitamei, Shoko Shioya

Abstract

Purpose: To investigate the 2-year outcomes of three monthly intravitreal ranibizumab injections followed by as-needed reinjections to treat polypoidal choroidal vasculopathy (PCV).

Methods: Seventy-five consecutive eyes with naïve symptomatic PCV with 2 years of follow-up after treatment were studied prospectively.

Results: The mean (±SD) numbers of injections were 4.2±1.3 that included three monthly injections in the loading phase and 1.6±1.7 during years 1 and 2, respectively (mean 2-year total, 5.6±1.9). The baseline logarithm of the minimum angle of resolution visual acuity (VA) was 0.59±0.51 that improved significantly (p=0.001 for both comparisons) to 0.37±0.33 and 0.41±0.40 at 1 and 2 years, respectively, after the first injection. Although no significant difference was found between years 1 and 2 after the first injection, the VA tended to decrease slightly during year 2. The improved foveal thickness was maintained during year 2. Thirty (40%) eyes and 19 (25%) eyes, respectively, at years 1 and 2 after the first injection had no polypoidal lesions on indocyanine green angiography. A branching vascular network (BVN) remained in all eyes 2 years after the first injection and tended to increase in size during year 2.

Conclusions: The 2-year outcomes showed significant VA and foveal thickness improvements in eyes with PCV. During year 2, the magnitude of the improvement was lower compared with year 1. An as-needed reinjection schedule might not prevent polypoidal lesions or BVNs from regrowing. Further investigations should establish a treatment strategy for PCV.

Figures

Figure 1
Figure 1
The changes in the mean logarithm of the minimum angle of resolution visual acuity during the 2-year follow-up period after the first ranibizumab injection to treat polypoidal choroidal vasculopathy in Japanese patients. The numbers in the parentheses indicate 1 SD of the mean.
Figure 2
Figure 2
The changes in the mean foveal thickness during the 2-year follow-up period after the first ranibizumab injection to treat polypoidal choroidal vasculopathy in Japanese patients. The numbers in the parentheses indicate 1 SD of the mean.
Figure 3
Figure 3
The left eye of a 71-year-old man with polypoidal choroidal vasculopathy. (A) At baseline, a fundus photograph shows a serous retinal detachment (SRD) involving the fovea (small arrows) and a serous pigment epithelial detachment (PED) (large arrows). (B) A horizontal optical coherence tomography (OCT) image shows a subfoveal SRD (large arrow) and PED temporal to the fovea (small arrow). (C) indocyanine green angiography (ICGA) shows polypoidal lesions (small arrows) and a branching vascular network (BVN) (large arrows). The planimetric size of the BVN is 4.33 mm2. (D and E) One year after the first injection of ranibizumab, a fundus photograph and OCT shows resolution of the SRD and PED. (F) ICGA shows regression of polypoidal lesions and no increase in the size of the BVN (4.42 mm2). (G) Two years after the first injection, a fundus photograph shows some elevated orange-red lesions (arrows). (H) A horizontal OCT image shows a recurrent subfoveal SRD (large arrow) and a PED temporal to the fovea (small arrow). (I) ICGA shows progression of the polypoidal lesions and the size of the BVN (5.75 mm2).

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