Outcomes in Eyes with Retinal Angiomatous Proliferation in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)

Abstract

Objective To compare baseline characteristics, visual acuity (VA) and morphological outcomes between eyes with retinal angiomatous proliferation (RAP) and all other eyes among patients with neovascular age-related macular degeneration (NVAMD) treated with anti-vascular endothelial growth factor (anti-VEGF) drugs. Design Prospective cohort study within the Comparison of AMD Treatments Trials (CATT). Participants Patients with NVAMD Methods Reading Center staff evaluated baseline and follow-up digital color fundus photographs (CFP), fluorescein angiograms (FA), and optical coherence tomograms (OCT) of eyes having NVAMD treated with either ranibizumab or bevacizumab over a 2-year period. RAP was identified by the intense intra-retinal leakage of fluorescein in combination with other associated features. Main outcome measures VA, fluorescein leakage, scar, geographic atrophy (GA) on FA and retinal thickness, fluid and subretinal hyperreflective material (SHRM) on OCT, and number of intravitreal anti-VEGF injections at 1 and 2 years. Results RAP was present in 126 of 1183 (10.7%) study eyes at baseline. Mean VA improvement from baseline was greater (10.6 vs 6.9 letters; p=0.01) at one year but similar at 2 years (7.8 vs 6.2; p=0.34). At 1 year, eyes with RAP were more likely to have: no fluid (46 vs 26%; p<0.001) on OCT, no leakage on FA (61 vs 50%; p=0.03), and greater reduction in foveal thickness (-240 vs -161u, p<0.001). They were more likely to develop GA (24 vs 15%; p=0.01), and less likely to develop scar (17 vs 36%; p<0.001), or SHRM (36 vs 48%; p=0.01). These results were similar at 2 years. The mean change in lesion size at 1 year differed (-0.27 vs 0.27 DA; p=0.02) but was similar at 2 years (0.49 vs 0.79; p=0.26). Among eyes treated PRN, eyes with RAP received a lower mean number of injections in year 1 (6.1 vs 7.4; p=0.003) and year 2 (5.4 vs 6.6; p=0.025). Conclusions At both 1 and 2 years after initiation of anti-VEGF treatment in CATT, eyes with RAP were less likely to have fluid, FA leakage, scar, and SHRM and more likely to have GA than eyes without RAP. Mean improvement in VA was similar at 2 years.

Type 3 neovascularisation: long-term analysis of visual acuity and optical coherence tomography anatomical outcomes

“…SHRM has been associated with a poor visual outcome and increased scar formation in an analysis of the participants in the CATT study 20. However, further analysis of this CATT cohort demonstrated that eyes with RAP lesions developed less SHRM and scarring but a greater rate of geographic atrophy24 versus eyes with other lesion types. In our study, presence or absence of SHRM was noted at baseline and its SD-OCT dimensions were measured after initiation of treatment of type 3 NV.…”

Multimodal Evaluation of the Fellow Eye of Patients with Retinal Angiomatous Proliferation

“…Previous reports described RPE atrophy, GA, and focal hyperpigmentation as common features in the fellow eyes of RAP [2,15,28]. Similarly, GA has been associated with impaired perfusion of the underlying CL [29].…”

“…Retinal angiomatous proliferation (RAP) or type 3 neovascularization (type 3 NV), is estimated to represent 8-20% of all cases of exudative age macular degeneration (eAMD) [1][2][3]. The disease has historically been considered to be bilaterally aggressive [4,5], with fellow eye involvement being evident, on average, 15 months after diagnosis [6].…”

Visual and Morphologic Outcomes in Eyes with Hard Exudate in the Comparison of Age-Related Macular Degeneration Treatments Trials

“…9 However unlike these two types of fluid sub-RPE fluid was not distributed similarly between the two groups (with and without HE) with more eyes that had HE having sub-RPE fluid suggesting that leakage from occult lesions was the primary source of fluid in eyes with HE. Unlike the CSME in diabetes which is usually associated with large cystic accumulations of intra-retinal fluid, presumably because the vascular pathology is located within the sensory retina, the CATT cohort patient study eyes with HE were not associated with petaloid patterns in fluorescein angiography (angiographic cystoid macular edema).…”