Original article
Delayed Patchy Choroidal Filling in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)

https://doi.org/10.1016/j.ajo.2014.06.004Get rights and content

Purpose

To determine the relationship between delayed patchy choroidal filling and morphologic and functional outcomes among eyes treated with ranibizumab or bevacizumab.

Methods

Comparison of Age-related Macular Degeneration Treatment Trials participants were assigned randomly to ranibizumab or bevacizumab on a monthly or as-needed schedule. Presence of delayed patchy choroidal filling and morphologic and functional outcomes were evaluated among eyes with gradable fluorescein angiography at baseline (n = 973) and at 1 year (n = 860) eyes.

Results

Delayed filling was present in 75 (7.7%) of 973 eyes at baseline. Eyes with incident delayed filling at 1 year (23 [2.9%] of 798) showed a mean decrease of 1.7 letters in visual acuity, whereas eyes without incident delayed filling had a mean improvement of 8.1 letters (difference [Δ], −9.8; 95% confidence interval [CI] , −15.8 to −3.9; P < .01). Eyes with incident delayed filling had a larger increase in mean total lesion area of choroidal neovascularization (3.00 mm2) than eyes without incident delayed filling (0.56 mm2; Δ , 2.4; 95% CI, 0.4 to 4.4; P = .02). The proportion with incident delayed filling at 1 year was similar among eyes treated with ranibizumab (10 [2.4%] of 413) or bevacizumab (13 [3.3%] of 385; P = .53) and among eyes treated monthly (12 [3.1%] of 388) or as needed (11 [2.7%] of 410; P = .83).

Conclusions

Delayed patchy choroidal filling was uncommon at baseline. Although only a small percentage of eyes demonstrated delayed filling during the first year of anti–vascular endothelial growth factor treatment, these eyes had worse visual acuity and a larger increase in total lesion area of choroidal neovascularization.

Section snippets

Methods

Institutional review board approval was obtained from the University of Pennsylvania and all participating CATT clinical centers. Each participant provided written informed consent that complied with the Health Insurance Portability and Accountability Act before entry into the study. Details regarding the methodology of the CATT study, an interventional double-masked trial, have been reported previously and also can be reviewed at ClinicalTrials.gov (identifier, NCT00593450).27 Below is a

Baseline Characteristics of Study Participants

Among the 1118 graded eyes, 973 (87.0%) were gradable for delayed patchy choroidal filling, and 75 (7.7%) of these had evidence of delayed patchy choroidal filling at baseline. Figure shows a typical case of delayed patchy choroidal filling.

The mean age was 79.3 years in patients with baseline delayed patchy choroidal filling and 78.8 years in patients with normal baseline choroidal filling; this difference was not statistically significant (difference [Δ], 0.5; 95% CI, −1.3 to 2.2; P = .62;

Discussion

The presence of delayed patchy choroidal filling was a relatively rare finding, observed at baseline in less than 8% of participants. In comparison with baseline, there was a small, but statistically significant, increase in delayed patchy choroidal filling after 1 year of treatment, suggesting a more delayed choroidal filling time at 1 year. Whether this is an effect of the anti-VEGF treatment or an effect of aging, which is known to be associated with decreased choroidal blood flow,29 cannot

Dina Y. Gewaily, MD, MSc is a rising second year fellow in Vitreo-retinal Disease and Surgery at the Scheie Eye Institute at the University of Pennsylvania, where she also completed her residency in ophthalmology. She is a graduate of Brown University's 8 year Program in Liberal Medical Education. At the Children's Hospital of Philadelphia, she is assistant surgeon in the gene therapy trials for Leber's Congenital Amaurosis. Her interests include clinical trials, teaching, and international

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    Dina Y. Gewaily, MD, MSc is a rising second year fellow in Vitreo-retinal Disease and Surgery at the Scheie Eye Institute at the University of Pennsylvania, where she also completed her residency in ophthalmology. She is a graduate of Brown University's 8 year Program in Liberal Medical Education. At the Children's Hospital of Philadelphia, she is assistant surgeon in the gene therapy trials for Leber's Congenital Amaurosis. Her interests include clinical trials, teaching, and international ophthalmology.

    Dr Juan E. Grunwald, MD, Professor of Ophthalmology at the University of Pennsylvania, is the Director of the Vivian Lasko Retinal Vascular Research Laboratory at the Scheie Eye Institute dedicated to research on ocular vascular physiology and pathology. One of his main interests is the elucidation of the role of blood flow abnormalities in the development of eye diseases. Dr Grunwald is a clinician, researcher and educator who specializes in the treatment of retinal diseases.

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