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Ebenezer Daniel, Juan E Grunwald, Benjamin J Kim, Maureen G Maguire, James A Shaffer, Glenn J Jaffe, Cynthia A Toth, Daniel F Martin, Frederick L Ferris, Gui-Shuang Ying; Hard Exudates and Treatment Outcomes in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). Invest. Ophthalmol. Vis. Sci. 2016;57(12):2653.
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© 2017 Association for Research in Vision and Ophthalmology.
To compare baseline characteristics, visual acuity (VA) and morphological outcomes between eyes with baseline hard exudates (HE) and all other eyes among patients with naive neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial growth factors (anti-VEGF).
Certified readers evaluated baseline and follow-up morphology on digital color fundus photographs, fluorescein angiography (FA), and optical coherence tomography (OCT) in eyes with nAMD that were randomly assigned to treatment with either ranibizumab or bevacizumab in a prospective cohort study. Ophthalmologists identified HE on color and red-free images.
HE were present in 128 of 1185 (11%) study eyes at baseline, 77% within 1 disc diameter area of the foveal center. HE patients were more likely female (81% vs 60%; p<0.001), non-smokers (53% vs 42%; p=0.004), and less likely to have a history of myocardial infarction (6% vs 13%; p=0.02). Both groups had similar proportions with hypertension, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia and congestive heart failure. At baseline, eyes with HE had worse VA (mean 57 vs 61 letters p=0.003), larger choroidal neovascularization (CNV) (2.2 vs 1.7 disc areas [DA]; p<0.004) and total lesion size (3.3 vs 2.4 DA; p <0.001), greater total retinal thickness (522 µm vs 452µm; p<0.001), more retinal angiomatous proliferation (18% vs 10%; p=0.009) and sub-RPE fluid (65% vs 47%; p<0.001). At 1 year, VA was similar in both groups; more eyes with HE at baseline had no fluid (45% vs 29%; p<0.001) and a greater reduction in mean total foveal thickness (-266 µm vs -158um, p<0.001). VA at year 2 remained similar between the two groups, but retinas with HE at baseline were thinner (267 µm vs 299µm, p=0.03) with less eyes with baseline HE having sub-retinal fluid (23% vs 36%; p=0.008). Scars and geographic atrophy were distributed similarly in both groups at years 1 and 2. Among 129 eyes with HE at baseline, 25 eyes (21%) at 1 year and 6 (5%) eyes at 2 years had HE..
Hard exudates were more common in females and non-smokers. Eyes with HE had a thicker retina and larger lesions but exhibited a more rapid resolution of fluid than eyes without hard exudates. HE is not associated with visual acuity, development of scar, or geographic atrophy at 1 and 2 years.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Total retinal thickness
Change in total retinal thickness
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