Long term Follow up of non-fibrotic scars in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT)

Abstract

Purpose : To describe changes associated with non-fibrotic retinal scars (NFS) through five years of follow-up in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).

Methods : Participants were assigned to ranibizumab or bevacizumab treatment and to 1 of 3 dosing regimens for 2 years, released from the clinical trial protocol after 2 years, and were recalled at 5 years. NFS was defined on color images as flat, small, well-circumscribed areas of pigmentation with varying degrees of central hypopigmentation without exposure of underlying choroidal vessels, occurring in the region of baseline choroidal neovascularization (CNV) (Figure). Active CNV was defined as intraretinal, subretinal, or sub-RPE fluid on OCT. Eyes with NFS at 1 year were evaluated for changes in pigmentation, visual acuity (VA), development of fibrotic scar (FS) and macular atrophy, through 5 years.

Results : Among 474 eyes with images at 1, 2 and 5 years, 39 (8.2%) had NFS at 1 year with a mean (standard deviation) VA of 80 (9) letters, ≈ 20/25. 62% had a complete ring of pigmentation. At 5 years 15% of eyes had increased pigmentation and 54% had decreased pigmentation with no associated loss of VA. Among eyes with NFS at one year, FS developed in 5% and 28% of eyes at 2 and 5 years. Non-geographic atrophy was observed in 35%, 41% and 51% of eyes at 1, 2 and 5 years. Geographic atrophy (GA) occurred in 5% and 21% of eyes at 2 and 5 years with significant loss of VA at 5 years in eyes that developed GA vs eyes that did not develop GA (74 vs 66 letters, p=0.04). 77% of eyes had active CNV at 5 years and these eyes had worse VA than eyes without active CNV (78 vs 71 letters, p= 0.05). (Table).

Conclusions : Eyes with NFS had good mean VA (≈ 20/25) at 1 year. FS developed in approximately one-fourth and GA in one-fifth of eyes with NFS. Eyes with active CNV and GA at 5 years had worse VA.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

Figure: Color images showing (A1-A3) a stable non-fibrotic scar (NFS); (B1-B3) showing a halo of non-geographic atrophy (NGA) in year 1 and 2 and geographic atrophy (GA) at year 5; (C1-C3) showing NGA at years 1 and 2 and GA at year 5; (D1-D3) showing fibrotic scar developing within the NFS with GA superiorly at 5 years; (E1-E3) showing GA at year 2 and fibrotic scar at year 5.

 

Table: Morphological and Visual changes in eyes through 4 years after detection of non-fibrotic scars.