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Ebenezer Daniel, Cynthia Toth, Juan Grunwald, Daniel Martin, Gui-Shuang Ying, Jiayan Huang, Glenn Jaffe, Stuart Fine, Maureen Maguire, CATT Research Group; 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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To describe risk factors for scarring of neovascularization during anti-VEGF therapy for age-related macular degeneration (AMD).
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.
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.
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.
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