Retinal pigment epithelial atrophy over polypoidal choroidal vasculopathy lesions during ranibizumab monotherapy

BACKGROUND: To evaluate the quantitative changes of retinal pigment epithelial (RPE) atrophy during 3-year follow-up period of ranibizumab monotherapy for polypoidal choroidal vasculopathy (PCV). METHODS: We retrospectively reviewed consecutive 100 Japanese patients with unilateral symptomatic treatment-naïve PCV who received ranibizumab monotherapy for 3 years. Color fundus photography, spectral-domain optical coherence tomography, and fundus autofluorescence were evaluated for RPE atrophy. Multiple regression analysis was performed to investigate the predictive factors found during univariate analysis to identify an association with increased RPE atrophic areas. RPE atrophic areas overlapping PCV lesions were measured. RESULTS: The mean (standard deviation) number of injections was 11.4 (4.50). RPE atrophic area enlarged to 2.91 (5.41 mm(2)) 3 years after the first injection from 1.22 (1.72 mm(2)) at baseline, which differed significantly (P = 0.012). Multiple regression analysis showed that larger PCV lesions and larger RPE atrophic areas at baseline were associated with increased RPE atrophic areas. RPE atrophic area overlapping the baseline PCV lesions significantly increased during 3-year follow-up period, whereas RPE atrophic area not overlapping the baseline PCV lesions did not increase significantly. CONCLUSION: RPE atrophy progresses in eyes with PCV during ranibizumab monotherapy and the tendency for development of RPE atrophy within the PCV lesions.