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Ebenezer Daniel, Maureen G Maguire, James Shaffer, Gui-Shuang Ying, Juan E Grunwald, Glenn J Jaffe, Daniel F Martin, ; Retinal Angiomatous Proliferation and Treatment Outcomes in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2833.
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To compare baseline characteristics, visual acuity (VA), treatment characteristics and morphological outcomes between eyes with Retinal Angiomatous Proliferation (RAP) and all other eyes among patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factors (anti-VEGF)
Certified graders evaluated baseline and follow-up morphology in digital color fundus photographs, fluorescein angiography (FA), and optical coherence tomography (OCT) of eyes having nAMD receiving randomly assigned treatment with either ranibizumab or bevacizumab and 3 different dosing regimens over a 2-year period in a prospective cohort study
RAP was present in 126 of 1183 (10.6%) study eyes at baseline. RAP patients were older (82 vs 79 years; p<0.001) and smoked less (45 vs 59%; p=0.004). At baseline, RAP eyes compared with other eyes had smaller choroidal neovascularization (CNV) (1.2 vs 1.9 disc areas [DA]; p<0.001), smaller total lesion size (1.6 vs 2.6 DA; p <0.001), more intraretinal fluid (93 vs 73%; p<0.001) and less subretinal fluid (67 vs 84%; p<0.001). A lower proportion had CNV at the foveal center (39.7 vs 60.3%; p<0.001) and a higher proportion had fluid on FA (48 vs 24%; p<0.001). At 1 year, RAP eyes had less fluid (54 vs 73%; p<0.001), less leakage on FA (34 vs 44%; p=0.03), more reduction in foveal thickness (-240 vs -161u, p<0.001), more GA (24 vs 15%; p=0.01), less scar (17 vs 36%; p<0.001), and less subretinal hyper reflective material (SHRM) (36 vs 48%; p=0.01) with similar results at 2 years. The mean VA improvement from baseline was greater (10.6 vs 6.9 letters; p=0.01) at one year but similar at 2 years (7.8 vs 6.2; p=0.34) (Figure). The mean change in lesion size at 1 year differed (-0.27 vs 0.27 DA; p=0.02) but was similar at 2 years (0.49 vs 0.79; p=0.26). Among eyes treated PRN, RAP eyes received a lower mean number of injections through both 1 year (6.07 vs 7.42; p=0.003) and 2 years (11.1 vs 13.6; p=0.01)
RAP eyes treated with anti-VEGF drugs in CATT were less likely to have FA leakage, scar, and SHRM and more likely to have GA at 1 or 2 years. Although VA gain was greater and lesion growth was less in RAP eyes at 1 year; by 2 years they were similar to other eyes
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