Association Between Circularity of Neovascular Lesion and Polypoidal Lesion Regression in Polypoidal Choroidal Vasculopathy.

Abstract

To evaluate the relationship between the circularity of neovascular lesion and the early regression of polypoidal lesions following anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with polypoidal choroidal vasculopathy (PCV). Retrospective, interventional case series. This retrospective study included treatment-naïve patients with PCV who underwent pre- and post-treatment swept-source optical coherence tomography angiography (SS-OCTA) images. The patients were classified into regressed and persistent groups depending on the regression of polypoidal lesions after 3 consecutive intravitreal anti-VEGF injections. Regression of polypoidal lesions was assessed using en face and B-mode SS-OCTA images. The baseline neovascular lesion circularity was measured using SS-OCTA images. The baseline characteristics, anatomical features, and best-corrected visual acuity (BCVA) were compared between the 2 groups. Receiver Operating Characteristic (ROC) curve analysis was performed to determine the optimal cut off value of neovascular lesion circularity for predicting polypoidal lesion regression. In addition, the association between baseline neovascular lesion circularity and BCVA after 1 year of treatment was assessed. The study included 42 eyes of 42 patients, 11 (24.2%) of whom showed polypoidal lesion regression after treatment. The baseline neovascular lesion circularity was significantly higher in the regressed group (0.50 ± 0.14) compared to the persistent group (0.36 ± 0.11. ROC analysis revealed an optimal neovascular lesion circularity cut-off value of 0.43, with an area under the curve of 0.809, sensitivity of 81.8%, and specificity of 83.3%. In multivariate linear regression analysis, higher baseline neovascular lesion circularity was independently associated with better visual improvement. Neovascular lesion circularity is a promising predictive marker for early regression of polypoidal lesions improves visual outcomes in patients with PCV. Patients with a more circular neovascular lesion morphology were more likely to respond favorably to anti-VEGF treatment. These findings suggest that OCTA-based assessment of neovascular lesion structures could guide personalized treatment strategies for PCV.