Five-Year Follow-up of Nonfibrotic Scars in the Comparison of Age-Related Macular Degeneration Treatments Trials
Ebenezer Daniel, Gui-Shuang Ying, Benjamin J Kim, Cynthia A Toth, Frederick Ferris 3rd, Daniel F Martin, Juan E Grunwald, Glenn J Jaffe, Joshua L Dunaief, Wei Pan, Maureen G Maguire, Comparison of Age-Related Macular Degeneration Treatments Trials, Ebenezer Daniel, Gui-Shuang Ying, Benjamin J Kim, Cynthia A Toth, Frederick Ferris 3rd, Daniel F Martin, Juan E Grunwald, Glenn J Jaffe, Joshua L Dunaief, Wei Pan, Maureen G Maguire, Comparison of Age-Related Macular Degeneration Treatments Trials
Abstract
Purpose: To describe changes in visual acuity (VA) and macular morphologic features at 5 years in eyes with nonfibrotic scar (NFS) identified at 1 year in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT).
Design: Prospective cohort study within a randomized clinical trial.
Participants: Participants in CATT.
Methods: Participants assigned to ranibizumab or bevacizumab and to 1 of 3 dosing regimens were released from the clinical trial protocol after 2 years and recalled at 5 years. Nonfibrotic scar was identified on color images at year 1 as flat, small, well-circumscribed areas of pigmentation with varying degrees of central hypopigmentation without exposure of underlying choroidal vessels at the site of baseline choroidal neovascularization. Follow-up images were assessed for changes in and around NFS.
Main outcome measures: Pigmentation changes, VA, development of fibrotic scar (FS), nongeographic atrophy (NGA), geographic atrophy (GA), retinal fluid on OCT, and fluorescein leakage.
Results: Among 474 eyes with images obtained at 1, 2, and 5 years, 39 (8.2%) showed NFS at 1 year with a mean VA of 80 letters (Snellen equivalent, 20/25). Among these eyes, FS developed in 5% at 2 years and 28% at 5 years. Nongeographic atrophy was observed in 34%, 47%, and 65% of eyes at 1, 2, and 5 years, respectively. Geographic atrophy developed in 5% of eyes at 2 years and 21% at 5 years. Among eyes with NFS, FS, or no scar at 1 year, mean VA at 5 years was 73 letters (20/32), 48 letters (20/100), and 62 letters (20/63), respectively. At 5 years, NFS eyes demonstrated less GA, less intraretinal fluid, more subretinal fluid, and less subretinal pigment epithelium fluid (all P < 0.01). Among NFS eyes, mean thickness of the retina, subretinal tissue complex, and total retina did not change across years 1 to 5 (P > 0.50). The proportion of eyes with fluid on OCT also did not change (P = 0.36). Subretinal hyperreflective material disappeared by 5 years in 40% of eyes with NFS.
Conclusions: These results indicate that, on average, eyes with NFS after anti-VEGF treatment have good VA not only at 1 and 2 years, but also through 5 years.
Trial registration: ClinicalTrials.gov NCT00593450.
Conflict of interest statement
Conflict of Interest: No conflicting relationship exists for any other author than described above.
Copyright © 2018 American Academy of Ophthalmology. All rights reserved.
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Source: PubMed