Changes of choroidal thickness and choroidal vascular layer thickness in macular fovea are of prognostic value in patients with polypoid choroidal vasculopathy treated by intravitreal injection of anti-vascular endothelial growth factor drugs_Chinese Journal of Ocular Fundus Diseases

Authors：

 Xiao Qing ¹ , Liu Chenwei ¹ , Li Lingna ² , Tang Guangbao ² , Dong Mingxia ¹ , Li Dongyu ³ , Liu Fang ¹

1. Department of Retinal Diseases, Tangshan Eye Hospital, Tangshan 063000, China;
2. Department of Ocular Function, Tangshan Eye Hospital, Tangshan 063000, China;
3. Department of Diabetic Retinopathy, Tangshan Eye Hospital, Tangshan 063000, China;

Corresponding?author：

Xiao Qing, Email: xiaoqing198509@163.com

Keywords：

Polypoidal choroidal vasculopathy; Large choroidal vessel layer thickness; Subfoveal choroidal thickness; Anti-vascular endothelial growth factor; Prognostic value

DOI：

10.3760/cma.j.cn511434-20251210-00570

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Objective To observe and analyze the subfoveal choroidal thickness (SFCT), large choroidal vessel layer thickness (LCVT), and their early changes, and to evaluate their prognostic value for treatment outcomes in eyes with polypoidal choroidal vasculopathy (PCV) receiving anti-vascular endothelial growth factor (VEGF) therapy. Methods A retrospective clinical study. A total of 120 patients (120 eyes) with unilateral PCV diagnosed and confirmed at Tangshan Eye Hospital from January 2020 to August 2024 were included. All affected eyes received intravitreal anti-VEGF injections. SFCT and LCVT were measured using swept-source optical coherence tomography (SS-OCT) before treatment and at 1, 3, 6, and 12 months after treatment. Based on the 12-month follow-up outcomes, the eyes were divided into a good prognosis group (69 eyes) and a poor prognosis group (51 eyes). Subretinal fluid (SRF) absorption was assessed by SS-OCT at 1 month after the first treatment (early stage). Repeated measures ANOVA was used to compare the dynamic changes of SFCT and LCVT between the two groups. Binary logistic regression, joint modeling, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and mediation analysis were used to evaluate the predictive value of SFCT and LCVT for prognosis. Results Compared with the good prognosis group, the poor prognosis group had significantly greater disease duration, best-corrected visual acuity, branching vascular network area, maximum linear lesion distance, proportion of choroidal vascular hyperpermeability, pigment epithelial detachment height, and pre-treatment SFCT and LCVT (P＜0.05). The good prognosis group had significantly lower SRF height (SRFH) before treatment and at 1 month after treatment, and a greater reduction in SRFH (ΔSRFH) within the first month, compared with the poor prognosis group (P＜0.05). At 1 month after treatment, complete SRF absorption was observed in 65 eyes (94.20%, 65/69) in the good prognosis group and 32 eyes (62.75%, 32/51) in the poor prognosis group; the complete SRF absorption rate was significantly higher in the good prognosis group (χ²=18.731, P＜0.001). Repeated measures ANOVA showed that SFCT and LCVT significantly decreased after treatment at different time points in both groups (P＜0.05); at each post-treatment time point, SFCT and LCVT were significantly higher in the poor prognosis group than in the good prognosis group (P＜0.05). Cohen's d effect size analysis showed that the intergroup difference in LCVT was greater than that in SFCT. ROC curve analysis showed that pre-treatment SFCT and LCVT effectively predicted early complete SRF absorption, and LCVT had significantly better diagnostic performance than SFCT [area under the ROC curve (AUC)=0.82, 0.76; P=0.025]. Joint modeling analysis showed that longitudinal changes in SFCT and LCVT were significantly associated with the risk of poor prognosis (P＜0.01); for every 50 μm increase in LCVT and SFCT, the relative risk of poor prognosis was 1.615 and 1.512, respectively. The Akaike information criterion value of the LCVT joint model (3 719.42) was lower than that of the SFCT model (3 852.67). At 1 month after treatment, ΔLCVT and ΔSFCT were both significant predictors of poor prognosis; in all adjusted models, the odds ratio of ΔLCVT was lower than that of ΔSFCT, indicating better predictive value. ROC curve analysis showed that both ΔSFCT and ΔLCVT had significant predictive value for poor prognosis, and ΔLCVT had significantly better predictive performance than ΔSFCT (AUC=0.81, 0.74). DCA showed that both ΔSFCT and ΔLCVT provided clinical net benefit, with ΔLCVT showing higher benefit. Mediation analysis showed that ΔLCVT and ΔSFCT partially improved prognosis by promoting early SRF absorption, with the indirect effect of ΔLCVT (39.35%) being higher than that of ΔSFCT (32.70%). Conclusions Both SFCT and LCVT can serve as predictors of prognosis in PCV eyes treated with anti-VEGF therapy. After controlling for the effect of SFCT, LCVT maintains independent predictive value, and its predictive efficacy is superior to that of SFCT.

Citation： Xiao Qing, Liu Chenwei, Li Lingna, Tang Guangbao, Dong Mingxia, Li Dongyu, Liu Fang. Changes of choroidal thickness and choroidal vascular layer thickness in macular fovea are of prognostic value in patients with polypoid choroidal vasculopathy treated by intravitreal injection of anti-vascular endothelial growth factor drugs. Chinese Journal of Ocular Fundus Diseases, 2026, 42(7): 566-577. doi: 10.3760/cma.j.cn511434-20251210-00570 Copy

1.	Arnold-Vangsted A, Schou MG, Balaratnasingam C, et al. Efficacy of intravitreal faricimab therapy for polypoidal choroidal vasculopathy: a systematic review and meta-analysis[J]. Acta Ophthalmol, 2025, 103(3): 247-256. DOI: 10.1111/aos.16797.
2.	Wang L, Liu S, He T, et al. Efficacy of intravitreal anti-VEGF agents in neovascular age-related macular degeneration patients with or without polypoidal choroidal vasculopathy: a meta-analysis[J]. Br J Hosp Med (Lond), 2025, 86(2): 1-22. DOI: 10.12968/hmed.2024.0673.
3.	Siedlecki J, Klaas JE, Keidel LF, et al. Progression of pachychoroid neovasculopathy into aneurysmal type 1 choroidal neovascularization or polypoidal choroidal vasculopathy[J]. Ophthalmol Retina, 2022, 6(9): 807-813. DOI: 10.1016/j.oret.2022.04.004.
4.	Bo Q, Zhang M, Chen J, et al. Progression of polypoidal lesions associated with exudative recurrence in polypoidal choroidal vasculopathy[J]. Ophthalmology, 2023, 130(2): 167-178. DOI: 10.1016/j.ophtha.2022.09.013.
5.	Zhang W, Chen Y. Review on classification of polypoidal choroidal vasculopathy[J/OL]. Int Ophthalmol, 2024, 44(1): 427[2024-11-12]. https://pubmed.ncbi.nlm.nih.gov/39531122/. DOI: 10.1007/s10792-024-03338-9.
6.	Shimizu Y, Miyata M, Ooto S, et al. Pachychoroid-phenotype effects on 5-year visual outcomes of anti-VEGF monotherapy in polypoidal choroidal vasculopathy[J/OL]. Acta Ophthalmol, 2022, 100(4): e943-e949[2021-09-17]. https://pubmed.ncbi.nlm.nih.gov/34533280/. DOI: 10.1111/aos.15015.
7.	Montorio D, Giordano M, Concilio M, et al. Structural and vascular changes of the choroid in polypoidal choroidal vasculopathy after intravitreal anti-VEGF therapy[J]. Ophthalmologica, 2022, 245(2): 173-178. DOI: 10.1159/000521071.
8.	Zhang Y, Wang J, Liu J, et al. Exploring the ability of novel choroidal biomarkers in predicting treatment outcomes of polypoidal choroidal vasculopathy[J]. Ophthalmic Res, 2024, 67(1): 573-583. DOI: 10.1159/000541572.
9.	Zhao J, Chandrasekaran PR, Cheong KX, et al. New concepts for the diagnosis of polypoidal choroidal vasculopathy[J/OL]. Diagnostics (Basel), 2023, 13(10): 1680[2023-05-09]. https://pubmed.ncbi.nlm.nih.gov/37238165/. DOI: 10.3390/diagnostics13101680.
10.	Wang Y, Xing D, Duan J, et al. Responsiveness of anti-VEGF treatment for polypoidal choroidal vasculopathy based on aqueous humour proteomics: a preliminary study[J/OL]. Acta Ophthalmol, 2025, 103(2): e136-e145[2024-10-18]. https://pubmed.ncbi.nlm.nih.gov/39420792/. DOI: 10.1111/aos.16768.
11.	Tang W, Qiu X, Guo J, et al. Proton beam irradiation with anti-VEGF therapy for polypoidal choroidal vasculopathy: results of a 24-month, phase Ⅱ randomized study[J]. Graefe's Arch Clin Exp Ophthalmol, 2025, 263(3): 659-668. DOI: 10.1007/s00417-024-06681-w.
12.	Gaggino A, Inferrera L, Milan S, et al. Six cases of polypoidal choroidal vasculopathy in eyes with choroidal Nevi[J]. Case Rep Ophthalmol, 2025, 16(1): 182-193. DOI: 10.1159/000543643.
13.	Zhou H, Zhao X, Wang S, et al. Determination of vascular endothelial growth factor-b concentrations in aqueous humor and plasma of neovascular age-related macular degeneration and polypoidal choroidal vasculopathy patients before and after anti-VEGF therapy[J]. Ophthalmol Ther, 2023, 12(2): 827-837. DOI: 10.1007/s40123-022-00618-4.
14.	熊曉媚, 林振強, 蔡晨希, 等. 肥厚型脈絡膜譜系疾病與脈絡膜, 渦靜脈, 鞏膜改變的研究進展[J]. 眼科學報, 2023, 38(10): 693-699. DOI: 10.12419/2308010001.Xiong XM, Lin ZQ, Cai CX, et al. Research progress on pachychoroid disease spectrum and changes in the choroid, vortex veins and sclera[J]. Eye Science, 2023, 38(10): 693-699. DOI: 10.12419/2308010001.
15.	Zhang L, Luo Y. Correlation analysis between OCT evaluation and postoperative visual prognosis of patients with age-related macular degeneration complicated with cataract[J/OL]. BMC Ophthalmol, 2025, 25(1): e266[2025-05-06]. https://pubmed.ncbi.nlm.nih.gov/40329206/. DOI: 10.1186/s12886-025-04094-9.
16.	Zhang W, Gu X, Li B, et al. Exploring and identifying the imaging biomarkers for predicting anti-VEGF treatment response in polypoidal choroidal vasculopathy: a prospective multicenter study[J/OL]. Ann Med, 2024, 56(1): 2393273[2024-08-27]. https://pubmed.ncbi.nlm.nih.gov/39189520/. DOI: 10.1080/07853890.2024.2393273.
17.	Quiroz-Reyes MA, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, et al. Comparative efficacy of photodynamic therapy (PDT), ranibizumab, aflibercept monotherapy, and combination therapies for polypoidal choroidal vasculopathy: a network meta-analysis of randomized controlled trials[J/OL]. BMC Ophthalmol, 2025, 25(1): 440[2025-07-31]. https://pubmed.ncbi.nlm.nih.gov/40745591/. DOI: 10.1186/s12886-025-04249-8.
18.	Lin TH, Lin HY, Tseng PC. Enhancing anti-vascular endothelial growth factor with photodynamic therapy for polypoidal choroidal vasculopathy: a meta-analysis[J]. Surv Ophthalmol, 2025, 70(3): 380-388. DOI: 10.1016/j.survophthal.2024.12.006.
19.	Tawiah R, Bondell H. Multilevel joint frailty model for hierarchically clustered binary and survival data[J]. Stat Med, 2023, 42(21): 3745-3763. DOI: 10.1002/sim.9829.
20.	Sirks MJ, van Dijk EHC, Ghalayini H, et al. The clinical spectrum of polypoidal choroidal vasculopathy in white patients: a retrospective multicenter cohort study[J]. Ophthalmol Retina, 2025, 9(10): 994-1004. DOI: 10.1016/j.oret.2025.04.019.
21.	Suzuki T, Sasajima H, Otaki C, et al. Association of subretinal fluid duration and baseline chorioretinal structure with optical coherence tomography in central serous chorioretinopathy[J/OL]. Transl Vis Sci Technol, 2023, 12(10): 12[2023-10-03]. https://pubmed.ncbi.nlm.nih.gov/37831445/. DOI: 10.1167/tvst.12.10.12.

1. Arnold-Vangsted A, Schou MG, Balaratnasingam C, et al. Efficacy of intravitreal faricimab therapy for polypoidal choroidal vasculopathy: a systematic review and meta-analysis[J]. Acta Ophthalmol, 2025, 103(3): 247-256. DOI: 10.1111/aos.16797.
2. Wang L, Liu S, He T, et al. Efficacy of intravitreal anti-VEGF agents in neovascular age-related macular degeneration patients with or without polypoidal choroidal vasculopathy: a meta-analysis[J]. Br J Hosp Med (Lond), 2025, 86(2): 1-22. DOI: 10.12968/hmed.2024.0673.
3. Siedlecki J, Klaas JE, Keidel LF, et al. Progression of pachychoroid neovasculopathy into aneurysmal type 1 choroidal neovascularization or polypoidal choroidal vasculopathy[J]. Ophthalmol Retina, 2022, 6(9): 807-813. DOI: 10.1016/j.oret.2022.04.004.
4. Bo Q, Zhang M, Chen J, et al. Progression of polypoidal lesions associated with exudative recurrence in polypoidal choroidal vasculopathy[J]. Ophthalmology, 2023, 130(2): 167-178. DOI: 10.1016/j.ophtha.2022.09.013.
5. Zhang W, Chen Y. Review on classification of polypoidal choroidal vasculopathy[J/OL]. Int Ophthalmol, 2024, 44(1): 427[2024-11-12]. https://pubmed.ncbi.nlm.nih.gov/39531122/. DOI: 10.1007/s10792-024-03338-9.
6. Shimizu Y, Miyata M, Ooto S, et al. Pachychoroid-phenotype effects on 5-year visual outcomes of anti-VEGF monotherapy in polypoidal choroidal vasculopathy[J/OL]. Acta Ophthalmol, 2022, 100(4): e943-e949[2021-09-17]. https://pubmed.ncbi.nlm.nih.gov/34533280/. DOI: 10.1111/aos.15015.
7. Montorio D, Giordano M, Concilio M, et al. Structural and vascular changes of the choroid in polypoidal choroidal vasculopathy after intravitreal anti-VEGF therapy[J]. Ophthalmologica, 2022, 245(2): 173-178. DOI: 10.1159/000521071.
8. Zhang Y, Wang J, Liu J, et al. Exploring the ability of novel choroidal biomarkers in predicting treatment outcomes of polypoidal choroidal vasculopathy[J]. Ophthalmic Res, 2024, 67(1): 573-583. DOI: 10.1159/000541572.
9. Zhao J, Chandrasekaran PR, Cheong KX, et al. New concepts for the diagnosis of polypoidal choroidal vasculopathy[J/OL]. Diagnostics (Basel), 2023, 13(10): 1680[2023-05-09]. https://pubmed.ncbi.nlm.nih.gov/37238165/. DOI: 10.3390/diagnostics13101680.
10. Wang Y, Xing D, Duan J, et al. Responsiveness of anti-VEGF treatment for polypoidal choroidal vasculopathy based on aqueous humour proteomics: a preliminary study[J/OL]. Acta Ophthalmol, 2025, 103(2): e136-e145[2024-10-18]. https://pubmed.ncbi.nlm.nih.gov/39420792/. DOI: 10.1111/aos.16768.
11. Tang W, Qiu X, Guo J, et al. Proton beam irradiation with anti-VEGF therapy for polypoidal choroidal vasculopathy: results of a 24-month, phase Ⅱ randomized study[J]. Graefe's Arch Clin Exp Ophthalmol, 2025, 263(3): 659-668. DOI: 10.1007/s00417-024-06681-w.
12. Gaggino A, Inferrera L, Milan S, et al. Six cases of polypoidal choroidal vasculopathy in eyes with choroidal Nevi[J]. Case Rep Ophthalmol, 2025, 16(1): 182-193. DOI: 10.1159/000543643.
13. Zhou H, Zhao X, Wang S, et al. Determination of vascular endothelial growth factor-b concentrations in aqueous humor and plasma of neovascular age-related macular degeneration and polypoidal choroidal vasculopathy patients before and after anti-VEGF therapy[J]. Ophthalmol Ther, 2023, 12(2): 827-837. DOI: 10.1007/s40123-022-00618-4.
14. 熊曉媚, 林振強, 蔡晨希, 等. 肥厚型脈絡膜譜系疾病與脈絡膜, 渦靜脈, 鞏膜改變的研究進展[J]. 眼科學報, 2023, 38(10): 693-699. DOI: 10.12419/2308010001.Xiong XM, Lin ZQ, Cai CX, et al. Research progress on pachychoroid disease spectrum and changes in the choroid, vortex veins and sclera[J]. Eye Science, 2023, 38(10): 693-699. DOI: 10.12419/2308010001.
15. Zhang L, Luo Y. Correlation analysis between OCT evaluation and postoperative visual prognosis of patients with age-related macular degeneration complicated with cataract[J/OL]. BMC Ophthalmol, 2025, 25(1): e266[2025-05-06]. https://pubmed.ncbi.nlm.nih.gov/40329206/. DOI: 10.1186/s12886-025-04094-9.
16. Zhang W, Gu X, Li B, et al. Exploring and identifying the imaging biomarkers for predicting anti-VEGF treatment response in polypoidal choroidal vasculopathy: a prospective multicenter study[J/OL]. Ann Med, 2024, 56(1): 2393273[2024-08-27]. https://pubmed.ncbi.nlm.nih.gov/39189520/. DOI: 10.1080/07853890.2024.2393273.
17. Quiroz-Reyes MA, Quiroz-Gonzalez EA, Quiroz-Gonzalez MA, et al. Comparative efficacy of photodynamic therapy (PDT), ranibizumab, aflibercept monotherapy, and combination therapies for polypoidal choroidal vasculopathy: a network meta-analysis of randomized controlled trials[J/OL]. BMC Ophthalmol, 2025, 25(1): 440[2025-07-31]. https://pubmed.ncbi.nlm.nih.gov/40745591/. DOI: 10.1186/s12886-025-04249-8.
18. Lin TH, Lin HY, Tseng PC. Enhancing anti-vascular endothelial growth factor with photodynamic therapy for polypoidal choroidal vasculopathy: a meta-analysis[J]. Surv Ophthalmol, 2025, 70(3): 380-388. DOI: 10.1016/j.survophthal.2024.12.006.
19. Tawiah R, Bondell H. Multilevel joint frailty model for hierarchically clustered binary and survival data[J]. Stat Med, 2023, 42(21): 3745-3763. DOI: 10.1002/sim.9829.
20. Sirks MJ, van Dijk EHC, Ghalayini H, et al. The clinical spectrum of polypoidal choroidal vasculopathy in white patients: a retrospective multicenter cohort study[J]. Ophthalmol Retina, 2025, 9(10): 994-1004. DOI: 10.1016/j.oret.2025.04.019.
21. Suzuki T, Sasajima H, Otaki C, et al. Association of subretinal fluid duration and baseline chorioretinal structure with optical coherence tomography in central serous chorioretinopathy[J/OL]. Transl Vis Sci Technol, 2023, 12(10): 12[2023-10-03]. https://pubmed.ncbi.nlm.nih.gov/37831445/. DOI: 10.1167/tvst.12.10.12.

Chinese Journal of Ocular Fundus Diseases

Changes of choroidal thickness and choroidal vascular layer thickness in macular fovea are of prognostic value in patients with polypoid choroidal vasculopathy treated by intravitreal injection of anti-vascular endothelial growth factor drugs

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