Incidence and characteristics of newly formed polypoidal lesions in polypoidal choroidal vasculopathy

To evaluate the incidence of newly formed polypoidal lesions (PLs) and associated neovascular lesion changes in eyes with polypoidal choroidal vasculopathy (PCV) using optical coherence tomography angiography (OCTA).

The medical records of patients diagnosed with PCV who were treated with intravitreal anti-vascular endothelial growth factor therapy and followed up for at least 3 years were retrospectively reviewed. Patients were classified into a new PL group or no new PL group based on the development of new PLs on OCTA during the follow-up period. The primary outcome measures included the incidence of new PLs and changes in morphological characteristics (area and circularity) of the neovascular lesions.

The final analysis included 45 eyes from 45 patients. New PLs were observed in 15 (33.3%) eyes. The new PL group demonstrated a significantly greater increase in neovascular lesion area compared with the no new PL group (1.63 ± 0.54 mm² vs. 0.19 ± 0.54 mm²; P = 0.041). Furthermore, the new PL group exhibited a significant decline in neovascular lesion circularity compared with the no new PL group (-0.052 ± 0.040 vs. 0.029 ± 0.030; P = 0.004). Most new PLs (80%) were classified as de novo, defined as those developing in a location where no neovascular lesions were present at the previous visit.

New PL formation frequently occurs in patients with PCV undergoing a treat-and-extend protocol. Expansion of the neovascular area and worsening of circularity have been identified as key precursors of new PL development.