Delayed patchy choroidal filling in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)

Abstract

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

Design: Cohort study.

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 mm(2)) than eyes without incident delayed filling (0.56 mm(2); 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.

Figure 1. Typical example of delayed patchy choroidal filling on fluorescein angiography in a Comparison of Age-related Treatment Trials participant

This figure represents a typical example of delayed patchy choroidal filling on fluorescein angiography of the left eye of a Comparison of Age-Related Treatment Trials study patient. The first image is a color fundus photograph of the left eye showing exudates and pigmentary changes in the macula. At 15 seconds in the arterial phase, several well-demarcated areas of relatively hypofluorescent patchy choroidal filling are visible in all quadrants of the macula. At 21 seconds, these patchy areas persist in the venous phase and are considered abnormally delayed. A choroidal neovascular membrane is evident. Residual mild patchiness can be seen at 24 seconds and it is not until the last frame of this figure that the delayed patchy choroidal filling resolves.