Outcomes in Eyes with Retinal Angiomatous Proliferation in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)

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• 作者：Ebenezer Daniel ; MPH ; PhD¹ ; ^{ebdaniel@mail.med.upenn.edu" class="auth_mail" title="E-mail the corresponding author} ; James Shaffer ; MS¹ ; Gui-shuang Ying ; PhD¹ ; Juan E. Grunwald ; MD¹ ; Daniel F. Martin ; MD² ; Glenn J. Jaffe ; MD³ ; Maureen G. Maguire ; PhD¹ ; for the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) Research Group^&lowast ;
• 关键词：CATT ; Comparison of Age-Related Macular Degeneration Treatments Trials ; CNV ; choroidal neovascularization ; DA ; disc area ; FA ; fluorescein angiography ; GA ; geographic atrophy ; NVAMD ; neovascular age-related macular degeneration ; OCT ; optical coherence tomography ; RAP ; retinal angiomatous proliferation ; RPE ; retinal pigment epithelium ; SHRM ; subretinal hyperreflective material ; VA ; visual acuity ; VEGF ; vascular endothelial growth factor
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：123
• 期：3
• 页码：609-616
• 全文大小：1443 K

文摘

To compare baseline characteristics, visual acuity (VA), and morphologic outcomes between eyes with retinal angiomatous proliferation (RAP) and all other eyes among patients with neovascular age-related macular degeneration (NVAMD) treated with anti–vascular endothelial growth factor (VEGF) drugs.

Design

Prospective cohort study within the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).

Participants

Patients with NVAMD.

Methods

Reading center staff evaluated digital color fundus photographs, fluorescein angiography (FA) images, and optical coherence tomography (OCT) scans of eyes with NVAMD treated with either ranibizumab or bevacizumab over a 2-year period. Retinal angiomatous proliferation was identified by the intense intra-retinal leakage of fluorescein in combination with other associated features.

Main Outcome Measures

Visual acuity; fluorescein leakage; scar; geographic atrophy (GA) on FA; retinal thickness, fluid, and subretinal hyperreflective material (SHRM) on OCT; and the number of intravitreal anti-VEGF injections at 1 and 2 years.

Results

Retinal angiomatous proliferation was present in 126 of 1183 (10.7%) study eyes at baseline. Mean VA improvement from baseline was greater (10.6 vs. 6.9 letters; P = 0.01) at 1 year, but similar at 2 years (7.8 vs. 6.2 letters; P = 0.34). At 1 year, eyes with RAP were more likely to have no fluid (46% vs. 26%; P < 0.001) on OCT, no leakage on FA (61% vs. 50%; P = 0.03), and greater reduction in foveal thickness (−240 μm vs. −161 μm; P < 0.001). They were more likely to demonstrate GA (24% vs. 15%; P = 0.01) and less likely to have scarring (17% vs. 36%; P < 0.001) or SHRM (36% vs. 48%; P = 0.01). These results were similar at 2 years. The mean change in lesion size at 1 year differed (−0.27 DA vs. 0.27 DA; P = 0.02), but was similar at 2 years (0.49 DA vs. 0.79 DA; P = 0.26). Among eyes treated PRN, eyes with RAP received a lower mean number of injections in year 1 (6.1 vs. 7.4; P = 0.003) and year 2 (5.4 vs. 6.6; P = 0.025).

Conclusions

At both 1 and 2 years after initiation of anti-VEGF treatment in CATT, eyes with RAP were less likely to have fluid, FA leakage, scar, and SHRM and more likely to have GA than eyes without RAP. Mean improvement in VA was similar at 2 years.