Five-Year Outcomes with Anti-Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration: The Comparison of Age-Related Macular Degeneration Treatments Trials

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• 作者：Comparison of Age-related Macular Degeneration Treatments Trials (CATT) Research Group^&lowast ;
• 关键词：AMD ; age-related macular degeneration ; CATT ; Comparison of Age-Related Macular Degeneration Treatments Trials ; OCT ; optical coherence tomography ; PRN ; pro re nata ; VA ; visual acuity ; VEGF ; vascular endothelial growth factor
• 刊名：Ophthalmology
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：123
• 期：8
• 页码：1751-1761
• 全文大小：711 K

文摘

To describe outcomes 5 years after initiating treatment with bevacizumab or ranibizumab for neovascular age-related macular degeneration (AMD).

Design

Cohort study.

Participants

Patients enrolled in the Comparison of AMD Treatments Trials.

Methods

Patients were assigned randomly to ranibizumab or bevacizumab and to 1 of 3 dosing regimens. After 2 years, patients were released from the clinical trial protocol. At 5 years, patients were recalled for examination.

Main Outcome Measures

Visual acuity (VA) and morphologic retinal features.

Results

Visual acuity was obtained for 647 of 914 (71%) living patients with average follow-up of 5.5 years. The mean number of examinations for AMD care after the clinical trial ended was 25.3, and the mean number of treatments was 15.4. Most patients (60%) were treated 1 time or more with a drug other than their assigned drug. At the 5-year visit, 50% of eyes had VA of 20/40 or better and 20% had VA of 20/200 or worse. Mean change in VA was −3 letters from baseline and −11 letters from 2 years. Among 467 eyes with fluorescein angiography, mean total lesion area was 12.9 mm², a mean of 4.8 mm² larger than at 2 years. Geographic atrophy was present in 213 of 515 (41%) gradable eyes and was subfoveal in 85 eyes (17%). Among 555 eyes with spectral-domain optical coherence tomography, 83% had fluid (61% intraretinal, 38% subretinal, and 36% sub–retinal pigment epithelium). Mean foveal total thickness was 278 μm, a decrease of 182 μm from baseline and 20 μm from 2 years. The retina was abnormally thin (<120 μm) in 36% of eyes. Between 2 and 5 years, the group originally assigned to ranibizumab for 2 years lost more VA than the bevacizumab group (−4 letters; P = 0.008). Otherwise, there were no statistically significant differences in VA or morphologic outcomes between drug or regimen groups.

Conclusions

Vision gains during the first 2 years were not maintained at 5 years. However, 50% of eyes had VA of 20/40 or better, confirming anti–vascular endothelial growth factor therapy as a major long-term therapeutic advance for neovascular AMD.