Importance of fluorescein angiography as a predictor of treatment response in patients with pachychoroid neovasculopathy

Abstract

Abstract The purpose of this study was to evaluate the treatment outcomes of patients with pachychoroid neovasculopathy (PNV) who received photodynamic therapy (PDT) combined with intravitreal anti-vascular endothelial growth factor (VEGF) agents, with a particular focus on the fluorescein angiography (FA) findings. We retrospectively studied 33 eyes of 32 consecutive treatment-naïve patients with PNV who were scheduled for PDT combined with anti-VEGF agents between November 2017 and May 2022, with a follow-up period of 1 year or longer. We classified patients into two groups: central serous chorioretinopathy (CSC)-dominant type and macular neovascularization (MNV)-dominant type based on the baseline FA findings. The best-corrected visual acuity (BCVA) was compared before treatment and at 3, 6, and 12 months after the initial treatment. Additionally, recurrence rate, and number of additional injections during the maintenance phase were assessed. We classified 19 eyes with the CSC-dominant type, and 14 eyes with the MNV-dominant type. The BCVA improved significantly 1 year after the initial treatment only in the CSC-dominant type (P = 0.001). The recurrence rate in the maintenance phase was lower in the CSC-dominant type (15.8%) compared to the MNV-dominant type (57.1%), a difference that reached significance (P = 0.024). This study highlights the distinct treatment outcomes between the CSC-dominant and MNV-dominant types; specifically, CSC-dominant type had better visual improvement and a lower recurrence rate than the MNV-dominant type. These differences underscore the potential of FA as a useful biomarker to predict visual outcomes and recurrence in the maintenance phase in patients with PNV.