June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Risk Factors for Scarring in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT)
Author Affiliations & Notes
  • Ebenezer Daniel
    Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
    Scheie Ophthalmology Reading Center, University of Pennsylvania, Philadelphia, PA
  • Cynthia Toth
    Department of Biomedical Engineering, Duke University, Durham, NC
    Department of Ophthalmology, Duke University, Durham, NC
  • Juan Grunwald
    Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
    Scheie Ophthalmology Reading Center, University of Pennsylvania, Philadelphia, PA
  • Daniel Martin
    Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH
  • Gui-Shuang Ying
    Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
    Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, PA
  • Jiayan Huang
    Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, PA
  • Glenn Jaffe
    Duke Reading Center, Duke University Eye Center, Durham, NC
    Department of Ophthalmology, Duke University, Durham, NC
  • Stuart Fine
    Department of Ophthalmology, University of Colorado-Denver, Aurora, CO
  • Maureen Maguire
    Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
    Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, PA
  • Footnotes
    Commercial Relationships Ebenezer Daniel, None; Cynthia Toth, Genentech (F), Bioptigen (F), Physical Sciences Inc. (F), Unlicensed (P); Juan Grunwald, None; Daniel Martin, None; Gui-Shuang Ying, None; Jiayan Huang, None; Glenn Jaffe, Heidelberg Engineering (C), Regeneron Pharmaceuticals (F), Neurotech USA (C), Abbott (C), Psivida (F), Pfizer (C), Bayer (C); Stuart Fine, None; Maureen Maguire, Inspire Pharmaceuticals (F), Amakem (F), IDx LLC (F), Merck (C)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 3661. doi:
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      Ebenezer Daniel, Cynthia Toth, Juan Grunwald, Daniel Martin, Gui-Shuang Ying, Jiayan Huang, Glenn Jaffe, Stuart Fine, Maureen Maguire, ; Risk Factors for Scarring in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). Invest. Ophthalmol. Vis. Sci. 2013;54(15):3661.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To describe risk factors for scarring of neovascularization during anti-VEGF therapy for age-related macular degeneration (AMD).

 
Methods
 

Participants with neovascularization were randomly assigned to treatment with ranibizumab (0.5mg) or bevacizumab (1.25mg) and to a dosing regimen of monthly injections for 2 years, PRN injections for 2 years, or monthly injections for 1 year and PRN injections the following year. Demographic, baseline ocular characteristics, and baseline lesion features of color photography, fluorescein angiography, and optical coherence tomography (OCT) were evaluated as risk factors for development of scarring within 2 years using univariate and multivariate time-dependent Cox proportional hazard models. Adjusted hazard ratios (aHR) and associated 95% confidence intervals (CIs) were estimated.

 
Results
 

Among 1053 eyes with no scarring at baseline and known scar status, scarring developed in 339 (32%) in the first year and 141 (13%) in the second year. Multivariate analysis (Table) showed increased risk of scarring with classic choroidal neovascularization and blocked fluorescence on angiography at baseline. OCT characteristics at baseline including greater retinal thickness, greater sub-RPE thickness, sub-retinal fluid in the fovea and sub-retinal hyper reflective material were associated with higher risk of scarring while RPE elevation was associated with lower risk. Treatment drug and regimen, and SNPs associated with AMD (CFH, HTRA1, ARMS2, C3) were not associated with incident scar.

 
Conclusions
 

Approximately half of the CATT participants developed scarring in two years of anti-VEGF treatment. Scar development did not differ with treatment drug and regimen. A number of baseline fluorescein angiographic and OCT features predict scar development. These risk factors for scarring, which is associated with poor visual outcome, may guide the development of treatments that decrease scarring of neovascular lesions.

 
 
Multivariate analysis of risk factors for scar incidence
 
Multivariate analysis of risk factors for scar incidence
 
Keywords: 412 age-related macular degeneration • 609 neovascularization • 580 lesion study  
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