Delayed Patchy Choroidal Filling in the Comparison of Age-related Macular Degeneration Treatment Trials (CATT)

Abstract

 

Purpose

 

To determine the relationship between delayed patchy choroidal filling (DPCF), a finding thought to be associated with decreased choroidal circulation, and morphologic and functional outcomes among eyes treated with ranibizumab or bevacizumab for neovascular age-related macular degeneration (AMD).

 

Methods

 

Cohort study within the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). Participants had active sub-foveal choroidal neovascularization (CNV) or CNV sequelae in the fovea and were randomly assigned to ranibizumab or bevacizumab on a monthly or as-needed (PRN) schedule. Masked readers evaluated fundus features on fluorescein angiography (FA) at baseline and one year. Morphologic and functional measures were compared between groups of eyes based on presence of DPCF. Main outcome measures were prevalence of DPCF at baseline, incidence of DPCF by one year, and morphologic and functional outcomes at one year.

 

Results

 

Seventy-five (7.7%) of 973 participants with gradeable photographs at baseline had DPCF. Baseline DPCF was not significantly associated with clinical or morphologic characteristics at baseline or one year. Among 798 eyes that showed no DPCF at baseline and had gradable photographs at one year, 23 (2.9%) developed new DPCF at one year. Incidence of DPCF was similar between drug groups (2.4% in ranibizumab vs. 3.3% in bevacizumab, Δ [95% confidence interval, CI]=1.0% [-1.1%, 3.3%], p=0.53) and dosing regimens (3.1% in monthly vs. 2.7% in PRN, Δ=0.4% [-1.9%, 2.7%], p=0.83). Eyes with incident DPCF at one year showed a mean decrease of 1.7 letters in visual acuity (VA), whereas eyes without incident DPCF had a mean improvement of 8.1 letters (Δ=-9.8 [-15.8, -3.9], p<0.01). Eyes with incident DPCF also had a larger increase in mean total CNV lesion area from baseline (3.00 mm2) than eyes without incident DPCF (0.56 mm2, Δ=2.4 [0.4, 4.4], p=0.02).

 

Conclusions

 

DPCF was rare at baseline (7.7%) and developed in a small percentage (2.9%) of eyes during the first year of anti-VEGF treatment. However, eyes with incident DPCF had worse visual acuity outcomes and a larger increase in total CNV lesion area. During anti-VEGF treatment, decreased choroidal blood flow resulting in DPCF may have a role in the development of worse morphologic and functional outcomes.

 

 

Typical example of delayed patchy choroidal filling (DPCF) on fluorescein angiography.

 

Keywords: 452 choroid • 550 imaging/image analysis: clinical • 688 retina