OCT Findings after Aflibercept injections May Help Guide Treatment Deferral in PCV: Study
Researchers have found in a new study that approximately half of eyes with complete polypoidal regression by 24 weeks remained quiescent long term without additional Aflibercept injections, while the remainder developed recurrent exudation requiring retreatment. Treatment deferral with close OCT monitoring may be considered cautiously in selected PCV eyes with smaller residual double-layer signs or a history of massive subretinal hemorrhage. In contrast, eyes with a larger residual double-layer sign (>2,000 μm in length and >100 μm in height) may have a higher recurrence risk and could benefit from continued treat-and-extend (TAE) therapy to reduce recurrence or new hemorrhage while maintaining visual outcomes. The study was published in JAMA Ophthalmology by Voraporn C. and colleagues.
To evaluate the efficacy of the PRN approach after complete regression of the lesion, researchers performed a prospective cohort study in four university hospitals of Thailand using data collected between August 2020 and September 2025. A total of 81 patients with active PCV who underwent three intravitreal injections of aflibercept 2.0 mg monthly were included in the trial. Patients showing complete regression of polyps in week 12 were switched to the PRN regimen with monthly follow-up in the first year and bimonthly follow-up in the second year.
Patients not regressed by week 12 underwent three more monthly injections of aflibercept, with switching to PRN follow-up in case of regression at week 24, and switch to the treat-and-extend regimen for eyes with non-regressive lesions. The primary outcome was an evaluation of fluid-free interval from initial regression to the next recurrence of the exudative form identified with OCT.
Key findings:
- Detailed tracking across 81 study eyes (mean age 64 ± 8 years; 54% female, 46% male) identified 32 eyes (40%) achieving complete polypoidal regression at week 12 or 24, yielding specific quantitative performance metrics.
- Among 26 evaluable eyes with complete regression, 13 eyes (50%; 95% CI, 30%–70%) experienced exudative disease recurrence within 2 years of starting PRN deferral.
- Life-table analyses demonstrated a fluid-free probability after regression of 57% (95% CI, 37%–77%) at week 24 and 53% (95% CI, 33%–73%) at week 84.
- Among 14 eyes experiencing recurrence, median best-corrected visual acuity declined by −3.5 letters (IQR, −5.0 to −0.25) from the preceding visit.
- Three eyes (21%; 95% CI, 5%–51%) lost 10 or more letters, and 5 eyes (36%; 95% CI, 13%–65%) developed new subretinal hemorrhage.
- Post-hoc exploratory analyses revealed that baseline massive subretinal hemorrhage was associated with significantly lower recurrence hazard (hazard ratio [HR], 0.18; 95% CI, 0.04–0.80; P = 0.01).
- In contrast, vascular leakage without baseline subretinal hemorrhage trended toward higher recurrence risk (HR, 2.65; 95% CI, 0.89–7.94; P = 0.07).
To conclude, even though achieving full resolution of polyps is of vital importance in the management of PCV, delayed treatment of polypoidal choroidal vasculopathy using an anti-VEGF drug PRN led to exudative recurrence in 50% of the cases over the course of two years. The major points of the conclusions drawn from this paper include the use of biomarkers post-treatment with OCT as a means to determine high-risk patients who should be monitored actively with anti-VEGF.
Reference:
Chaikitmongkol V, Boonyot P, Patikulsila D, et al. Outcomes of As-Needed Aflibercept Treatment After Complete Regression in Polypoidal Choroidal Vasculopathy. JAMA Ophthalmol. Published online September 17, 2026. doi:10.1001/jamaophthalmol.2026.3927
