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Glenn J. Jaffe, Maureen G. Maguire, Cynthia A. Toth, Gui-Shuang Ying, Jiayan Huang, Ebenezer Daniel, Juan E. Grunwald, Daniel F. Martin, CATT Study Group; Correlation of Retinal Morphology and Visual Acuity in the Comparison of Age-Related Macular Degeneration Treatment Trial (CATT). Invest. Ophthalmol. Vis. Sci. 2012;53(14):2893.
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The morphologic patterns after treatment with the VEGF drugs ranibizumab (L) and bevacizumab (A) and the relationship of the morphologic features with visual acuity (VA), and whether it is necessary to eliminate all excess fluid to achieve optimal VA, are not well understood. We describe the effect of different anti-VEGF treatment strategies on lesion activity, as measured by OCT and FA, and visual acuity outcomes in CATT.
Stratus OCT, obtained at baseline and at monthly intervals through wk 52, and FA obtained at baseline and wk 52 from 1185 subjects were interpreted by centralized Reading Centers. The frequency of OCT-determined intraretinal fluid (IRF), subretinal fluid (SRF), and subRPE fluid (SRPEF), retinal and subretinal thickness, and FA-determined leakage, stratified by treatment group (L and A, monthly or PRN) was correlated with VA.
Fluid of all 3 types (IRF, SRF, SRPEF) and retinal and subretinal tissue thickness, decreased in all 4 treatment groups throughout the study. More eyes treated with L than A had no fluid at 52 wks; however, the majority of eyes (55% in L monthly, 74-80% in other groups) still had fluid, most commonly IRF (37-58%), at 1 year. In all treatment groups, average VA increased by wk 52, but at all time points, eyes with residual IRF, and not those with SRF or SRPEF, had worse mean VA (6 to 7 letters). Retinal thickness decreased markedly by 4 weeks, with the greater mean decrease in L eyes (155 u) compared to A eyes (127 u) and lowest mean thickness at 1 year (266 u) with L monthly than with the other treatments (294-308 u). VA and intraretinal thickness were not related linearly, ie, eyes with abnormally thin (<120 u) or thick (>212u) retinas had worse VA than those with normal thickness (120-212 u). At wk 52, larger CNV lesions had worse VA, (r=-0.25), and eyes with monthly treatment had smaller CNV area than those on PRN treatment.
Anti-VEGF therapy reduces CNV lesion activity and improves VA in all treatment groups, but at all time points those with residual IRF had worse VA than those without. Abnormally thin or thick retinas had worse VA. Monthly L dosing yielded more eyes with no fluid and lower mean retinal thickness, although the long-term significance is yet unknown. These results have important treatment implications in eyes undergoing anti-VEGF therapy for NVAMD.
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