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Outcomes of eyes with lesions composed of >50% blood in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT)
Journal article   Open access   Peer reviewed

Outcomes of eyes with lesions composed of >50% blood in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT)

Michael M Altaweel, Ebenezer Daniel, Daniel F Martin, Robert A Mittra, Juan E Grunwald, Michael M Lai, Alexander Melamud, Lawrence S Morse, Jiayan Huang, Frederick L Ferris III, …
Ophthalmology (Rochester, Minn.), Vol.122(2), pp.391-398.e5
02/2015
DOI: 10.1016/j.ophtha.2014.08.020
PMCID: PMC4306628
PMID: 25307130
url
http://doi.org/10.1016/j.ophtha.2014.08.020View
Open Access

Abstract

To compare baseline characteristics, treatment frequency, visual acuity (VA), and morphologic outcomes of eyes with >50% of the lesion composed of blood (B50 group) versus all other eyes (Other group) enrolled in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). Prospective cohort study within a multicenter randomized clinical trial. CATT patients with neovascular age-related macular degeneration (AMD). Treatment for the study eye was assigned randomly to either ranibizumab or bevacizumab and to 3 different dosing regimens over a 2-year period. Reading center graders evaluated baseline and follow-up morphology in color fundus photographs, fluorescein angiography (FA), and optical coherence tomography (OCT). Masked examiners tested VA. Morphologic features and VA at 1 and 2 years. The B50 group consisted of 84 of 1185 (7.1%) patients enrolled in CATT. Baseline lesion characteristics differed between groups. In the B50 group, choroidal neovascularization size was smaller (0.73 vs 1.83 disc areas [DA]; P < 0.001), total lesion size was greater (4.55 vs 2.31 DA; P <0.001), total retinal thickness was greater (524 vs 455 μm; P = 0.02), and mean VA was worse (56.0 vs 60.9 letters; P = 0.002). Increases in mean VA were similar in the B50 and Other groups at 1 year (+9.3 vs +7.2 letters; P = 0.22) and at 2 years (9.0 vs 6.1 letters; P = 0.17). Eyes treated PRN received a similar number of injections in the 2 groups (12.2 vs 13.4; P = 0.27). Mean lesion size in the B50 group decreased by 1.2 DA at both 1 and 2 years (primarily owing to resolution of hemorrhage) and increased in the Other group by 0.33 DA at 1 year and 0.91 DA at 2 years (P < 0.001). Leakage on FA and fluid on OCT were similar between groups at 1 and 2 years. In CATT, the B50 group had a visual prognosis similar to the Other group. Lesion size decreased markedly through 2 years. Eyes like those enrolled in CATT with neovascular AMD lesions composed of >50% blood can be managed similarly to those with less or no blood.
 Choroidal Neovascularization - diagnosis Prospective Studies Follow-Up Studies Intravitreal Injections Humans Male Wet Macular Degeneration - physiopathology Vascular Endothelial Growth Factor A - antagonists & inhibitors Bevacizumab Angiogenesis Inhibitors - administration & dosage Retinal Hemorrhage - diagnosis Antibodies, Monoclonal, Humanized - administration & dosage Choroidal Neovascularization - drug therapy Ranibizumab Aged, 80 and over Angiogenesis Inhibitors - therapeutic use Female Visual Acuity - physiology Fluorescein Angiography Retinal Hemorrhage - physiopathology Antibodies, Monoclonal, Humanized - therapeutic use Tomography, Optical Coherence Treatment Outcome Choroidal Neovascularization - physiopathology Wet Macular Degeneration - diagnosis Wet Macular Degeneration - drug therapy Aged Retinal Hemorrhage - drug therapy Cohort Studies

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