Post-loading Polypoidal Lesion Height and Optical Coherence Tomography Angiography-Defined Regression in Polypoidal Choroidal Vasculopathy

Purpose: To evaluate the association between post-loading polypoidal lesion height and optical coherence tomography angiography (OCTA)-defined regression in treatment-naive eyes with polypoidal choroidal vasculopathy (PCV). Methods: This retrospective cohort study included 51 treatment-naive patients with PCV and a single polypoidal lesion identified on both baseline indocyanine green angiography and OCTA. Patients received three consecutive monthly intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. OCTA-defined regression was defined as the absence of a polypoidal vascular structure on en face OCTA, with flow signals detected in no more than one cross-sectional B-scan slice. Polypoidal lesion height was measured using B-mode optical coherence tomography (OCT). Linear regression analysis adjusted for baseline polypoidal lesion height and receiver operating characteristic curve analysis were performed. Results: During follow-up, polypoidal lesions regressed in 10 (19.6%) eyes and persisted in 41 (80.4%) eyes. The regressed group had a lower polypoidal lesion height than the persistent group (96.8 ± 67.5 μm vs. 232.8 ± 164.7 μm, P = 0.003). After adjustment for baseline lesion height, OCTA-defined regression was associated with a lower post-loading polypoidal lesion height (β = -110.45 μm; 95% confidence interval, -190.27 to -30.63; P = 0.008), and the optimal cutoff was 94.5 μm (area under the curve, 0.806; sensitivity, 80.0%; specificity, 80.0%). Conclusions: Lower post-loading polypoidal lesion height on B-mode OCT was associated with OCTA-defined regression after anti-VEGF loading therapy. Although the identified cutoff requires validation, post-loading polypoidal lesion height may serve as a practical, accessible OCT-based structural biomarker for estimating OCTA-defined regression during routine clinical follow-up.