This prospective cohort study (n=81 treatment-naive eyes, 4 Thai university hospitals) evaluated outcomes of as-needed (PRN) aflibercept 2.0 mg after achieving complete polypoidal regression in PCV, following 3 or 6 monthly loading injections, with monthly follow-up in year 1 and bimonthly in year 2.
Of 32 eyes (40%) achieving complete regression, 13/26 evaluable eyes (50%; 95% CI, 30%–70%) recurred within 2 years; fluid-free probability was 57% at week 24 and 53% at week 84. At recurrence, median BCVA loss was -3.5 letters, 21% lost ≥10 letters, and 36% developed new hemorrhage. Baseline massive subretinal hemorrhage was associated with lower recurrence risk (HR 0.18; p=0.01).
Small sample size (only 26 eyes reached the primary analysis), post hoc exploratory biomarker analyses are hypothesis-generating only, and the single-country Thai cohort may limit generalizability to other PCV populations.
After complete polypoidal regression with aflibercept, PRN management keeps about half of eyes quiescent for up to 2 years, but the other half recur with measurable vision loss and hemorrhage risk — so close monitoring and OCT biomarker review (especially presence of leakage without subretinal hemorrhage) should guide whether to defer or continue treatment.
