Short-term outcomes and choroidal morphological changes following aflibercept therapy in pachychoroid neovasculopathy

To evaluate the short-term outcomes and choroidal morphological changes after three monthly aflibercept injections for pachychoroid neovasculopathy (PNV). Twenty-nine treatment-naïve patients with PNV were enrolled in this prospective phase IV clinical trial. All patients received three monthly injections of aflibercept. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured at baseline and at week 12 (4 weeks after the third injection). Additionally, changes in the subfoveal choroidal thickness (SCT), largest choroidal vessel diameter, and area of the choriocapillaris-Sattler's and Haller's layers between baseline and week 12 were assessed. The BCVA improved from 67.5 ± 10.8 Early Treatment Diabetic Retinopathy Study (ETDRS) letters at baseline to 74.3 ± 10.7 letters at week 12. CRT decreased from 348.5 ± 77.4 μm at baseline to 254.3 ± 72.9 μm at week 12. Complete resolution of the retinal fluid was observed in 86.2% of cases at week 12. At baseline and 12 weeks, the SCT measured 388.3 ± 77.4 μm and 344.9 ± 91.9 μm, respectively, while the diameter of the largest choroidal vessel measured 280.3 ± 62.0 μm and 247.8 ± 57.6 μm, respectively. The areas of the choriocapillaris-Sattler's layer and Haller's layer at the corresponding time points were 0.56 ± 0.14 mm² and 0.57 ± 0.14 mm², and 1.56 ± 0.42 mm² and 1.40 ± 0.45 mm², respectively. Aflibercept loading injections for PNV resulted in both short-term visual and anatomical improvements. Notably, the reduction in the area of Haller's layer and choroidal vessel diameter after treatment suggests that aflibercept exerts an impact on this region of the choroid.