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Michael Altaweel, Juan Grunwald, Ebenezer Daniel, Gui-Shuang Ying, Jiayan Huang, Glenn Jaffe, Comparison of Age-related Macular Degeneration Treatments Trials Research Group; Clinical Outcomes of Eyes with Neovascular Lesions Composed of >50% Blood Treated with Anti-VEGF Therapy in the Comparison of AMD Treatments Trials (CATT). Invest. Ophthalmol. Vis. Sci. 2013;54(15):4162.
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To compare baseline characteristics, treatment requirements, visual acuity (VA), and morphologic outcomes of eyes enrolled with > 50% of the total lesion composed of blood versus all other eyes enrolled in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).
Cohort study within CATT. Participants were randomly assigned to treatment with ranibizumab or bevacizumab 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. Masked trained readers evaluated baseline and follow-up morphology in color fundus photographs, fluorescein angiograms (FA), and optical coherence tomography.
84 of 1185 patients enrolled in CATT had lesions composed of >50% blood at baseline (B50 group). Baseline demographic characteristics were similar between the B50 group and the eyes with no or less blood (Other group) but lesion characteristics differed markedly. While CNV size was smaller in the B50 group (0.73 Disc Areas vs 1.83 DA; p <0.0001) the total lesion size was much larger (4.55 DA vs 2.31 DA; p <0.0001). Central retinal thickness was also greater in the B50 group (524 um vs 455 um). Mean baseline VA was worse in the B50 group (56 letters) than the Other group (60.9 letters). VA in the B50 group improved by a mean of 9.26 letters at 1 year and 9.44 letters at 2 years; similar to the improvement in the Other group (7.17 and 6.15, respectively). The percentage gaining 3 lines was similar for both groups (34.3% and 29.5% respectively). Eyes treated PRN required a similar number of injections in the two groups. Mean total lesion size in the B50 group decreased by a mean of 1.2 DA at 1 year and at 2 years while mean lesion size in the Other group increased by 0.33 DA at 1 year and 0.91 DA at 2 years (p<0.001). Mean retinal thickness also decreased more in the B50 group (-355 um vs -287um; p < 0.005). Lesion activity, as determined by leakage on FA, was similar between groups at both time intervals.
The B50 group had a visual prognosis similar to the Other group when treated according to the CATT protocol. Lesion size decreased markedly through 2 years. Eyes with neovascular AMD lesions composed of >50% blood can be managed clinically in a similar manner as those with less or no blood.
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