Recalcitrant Peripapillary Pachychoroid Syndrome Responds to High-Dose Aflibercept Therapy

To describe a case of recalcitrant bilateral peripapillary pachychoroid syndrome (PPS) treated with high-dose (HD) intravitreal aflibercept injections. Medical and imaging records were retrospectively evaluated. Multimodal imaging included ultra-widefield indocyanine green and fluorescein angiography and fundus autofluorescence. Tracked optical coherence tomography (OCT) B scans were reviewed to assess intra- (IRF) and subretinal fluid (SRF), and to measure choroidal thickness (CT). Macular neovascularization was excluded with OCT angiography. A 75-year-old man with bilateral PPS and severe peripapillary and macular edema underwent multiple sessions of photodynamic therapy, intravitreal aflibercept injections, and corticosteroid eye drop application with minimal improvement of the fluid. After two monthly intravitreal HD aflibercept injections, the peripapillary and macular fluid was almost completely resolved with commensurate choroidal thickness reduction and significant visual gain in each eye. High-dose intravitreal aflibercept therapy may lead to remarkable anatomical and functional improvement in eyes with recalcitrant PPS.