Abstract
Objective
To evaluate the impact of subfoveal choroidal thickness (SFCT) and other clinical
biomarkers in intravitreal anti-vascular endothelial growth factor response in treatment-naive
Caucasian patients diagnosed with polypoidal choroidal vasculopathy (PCV/AT1).
Design
Cross-sectional study.
Participants
Treatment-naive patients diagnosed with PCV/AT1 recruited in a single centre from
January 2013 to December 2020.
Methods
Eligibility was determined in treatment-naive PCV patients who received a loading
dose of 3 injections of 0.5 mg ranibizumab. A diagnosis of PCV/AT1 was made based
on the diagnostic criteria in the efficacy and safety of verteporfin photodynamic
therapy in combination with ranibizumab or alone versus ranibizumab monotherapy in
patients with sumptomatic macular polypoidal choroidal vasculopathy study. Choroidal
thickness was manually measured by enhanced depth imaging technology in Spectralis
spectral domain optical coherence tomography.
Results
Eighty-three eyes of 83 patients were included in this study, 47 patients diagnosed
with PCV/AT1 with a good response to 3 intravitreal injections of ranibizumab and
36 with a poor response. The receiver operating characteristic curve of treatment
effect against the SFCT revealed that the area under the curve was 0.85 (range, 0.74–0.96).
Based on the Youden index, the optimal SFCT cut-off point for predicting a poor response
to anti-vascular endothelial growth factor is 257 µm. In the multivariate analysis,
the SFCT remained statistically significant (odds ratio 1.02 [range, 1.01–1.04]; P = 0.008). The combined effect of treatment effect against clinical biomarkers produced
an area under the curve of 0.90 (range, 0.82–0.98).
Conclusion
SFCT is a risk factor for a poor response to the 3 loading injections of ranibizumab
in treatment-naive PCV/AT1 Caucasian patients. A cut-off point of 257 µm could be
a valuable parameter for defining the population at risk for an inadequate response
to ranibizumab.
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Article Info
Publication History
Published online: October 19, 2021
Publication stage
In Press Corrected ProofIdentification
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© 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.