Purpose <p>To evaluate the 3-year outcomes of polypoidal choroidal vasculopathy (PCV) according to early polypoidal regression on swept-source optical coherence tomography angiography (SS-OCTA).</p> Methods <p>The medical records of 48 polypoidal lesions from 29 eyes of 29 patients diagnosed with PCV with a follow-up ≥3 years were retrospectively reviewed. Patients were divided according to SS-OCTA-defined polypoidal regression 3 months after the initial treatment into the regressed and persistent group. SS-OCTA images were analysed for microvascular and structural changes associated with early complete polypoidal regression.</p> Results <p>Compared with the persistent group, the regressed group (20 eyes), had better best-corrected visual acuity (BCVA) at 1 and 3 years (<i>p</i> = 0.000, <i>p</i> = 0.026, respectively) and less patients diagnosed with systemic hypertension (<i>p</i> = 0.043). The number of persistent polypoidal lesions 3 months after the initial treatment was significantly correlated with BCVA at 1 and 3 years (r = 0.498 <i>p</i> = 0.006 and r = 0.397 <i>p</i> = 0.033, respectively). Age, hypertension, number of persistent polypoidal lesions observed 3 months after initial treatment, and the baseline subfoveal choroidal thickness were also associated with the BCVA at 3 years after treatment. Early complete polypoidal regression was associated with a smaller hyperreflective lesion area within pigment epithelial detachment (PED) (<i>p</i> = 0.047, <i>p</i> = 0.024) and more flow signals in hyperreflective lesions (<i>p</i> = 0.047).</p> Conclusions <p>Eyes with early polypoidal regression showed better long-term visual outcomes than those with persistent polypoidal lesions. A smaller hyperreflective lesion area within the PED and more flow signals in the hyperreflective lesions could be considered favourable characteristics for early complete polypoidal regression.</p>