RECALCITRANT PERIPAPILLARY PACHYCHOROID SYNDROME RESPONDS TO HIGH-DOSE AFLIBERCEPT THERAPY

Area of Science:

• Ophthalmology
• Retinal Diseases
• Vascular Biology

Background:

• Peripapillary pachychoroid syndrome (PPS) is a condition characterized by fluid accumulation and thickening of the choroid.
• Recalcitrant cases of PPS often show limited response to standard treatments, posing a clinical challenge.

Purpose of the Study:

• To report a case of bilateral peripapillary pachychoroid syndrome (PPS) that was resistant to conventional therapies.
• To evaluate the efficacy of high-dose (HD) intravitreal aflibercept injections in managing recalcitrant PPS.

Main Methods:

• Retrospective analysis of medical and imaging data from a single patient with bilateral PPS.
• Utilized multimodal imaging including ultra-widefield indocyanine green and fluorescein angiography, fundus autofluorescence, and OCT angiography.
• Assessed intraretinal fluid (IRF), subretinal fluid (SRF), and choroidal thickness (CT) via OCT B scans.

Main Results:

• A 75-year-old male with severe bilateral PPS and edema showed minimal improvement with prior treatments (photodynamic therapy, standard aflibercept, corticosteroids).
• Following two monthly intravitreal HD aflibercept injections, near-complete resolution of peripapillary and macular fluid was observed.
• Significant visual acuity gains and reduction in choroidal thickness were noted in both eyes.

Conclusions:

• High-dose intravitreal aflibercept demonstrates potential as an effective treatment for recalcitrant peripapillary pachychoroid syndrome (PPS).
• This therapeutic approach may offer substantial anatomical and functional recovery in challenging PPS cases.