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Randomized Controlled Trial
. 2016 Apr;123(4):858-64.
doi: 10.1016/j.ophtha.2015.11.030. Epub 2016 Jan 8.

Angiographic Cystoid Macular Edema and Outcomes in the Comparison of Age-Related Macular Degeneration Treatments Trials

Neepa Shah  1 , Maureen G Maguire  2 , Daniel F Martin  3 , James Shaffer  2 , Gui-Shuang Ying  2 , Juan E Grunwald  2 , Cynthia A Toth  4 , Glenn J Jaffe  4 , Ebenezer Daniel  2 ; Comparison of Age-related Macular Degeneration Treatments Trials Research Group
Collaborators, Affiliations
Randomized Controlled Trial

Angiographic Cystoid Macular Edema and Outcomes in the Comparison of Age-Related Macular Degeneration Treatments Trials

Neepa Shah et al. Ophthalmology. 2016 Apr.

Abstract

Purpose: To describe morphologic and visual outcomes in eyes with angiographic cystoid macular edema (CME) treated with ranibizumab or bevacizumab for neovascular age-related macular degeneration (nAMD).

Design: Prospective cohort study within a randomized clinical trial.

Participants: A total of 1185 CATT study subjects.

Methods: Baseline fluorescein angiography (FA) images of all CATT study eyes were evaluated for CME. Grading of other characteristics on optical coherence tomography (OCT) and photographic images at baseline and during 2-year follow-up was completed by readers at the CATT Reading Centers. Three groups were created on the basis of baseline CME and intraretinal fluid (IRF) status: (1) CME, (2) IRF without CME, (3) neither CME nor IRF.

Main outcome measures: Visual acuity (VA) and total central retinal thickness (CRT) on OCT at baseline, year 1, and year 2.

Results: Among 1131 participants with images of sufficient quality for determining CME and IRF at baseline, 92 (8.1%) had CME, 766 (67.7%) had IRF without CME, and 273 (24.1%) had neither. At baseline, eyes with CME had worse mean VA (letters) than eyes with IRF without CME and eyes with neither CME nor IRF (52 vs. 60 vs. 66 letters, P < 0.001); higher mean total CRT (μm) on OCT (514 vs. 472 vs. 404, P < 0.001); and greater hemorrhage, retinal angiomatous proliferation (RAP) lesions, and classic choroidal neovascularization (CNV). All groups showed improvement in VA at follow-up; however, the CME group started and ended with the worst VA among the 3 groups. Central retinal thickness, although higher at baseline for the CME group, was similar at 1 and 2 years follow-up for all groups. More eyes with CME (65.3%) developed scarring during 2 years of follow-up compared with eyes with IRF without CME (43.8%) and eyes with neither CME nor IRF (32.5%; P < 0.001).

Conclusions: In CATT, eyes with CME had worse baseline and follow-up VA, although all groups showed similar rates of improvement in VA during 2 years of follow-up. Cystoid macular edema seems to be a marker for poorer visual outcomes in nAMD because of underlying baseline retinal dysfunction and subsequent scarring.

Trial registration: ClinicalTrials.gov NCT00593450.

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Figures

Figure 1
Figure 1. Example of subject with angiographic cystoid macular edema
Color fundus photo of the left eye (left) showing pigmentary changes along with drusen; early frame of fluorescein angiogram (center) showing multiple parafoveal areas of hyperfluorescence corresponding to drusen as well as CNV; late frame of angiogram (right) showing petaloid leakage around the fovea.
Figure 2
Figure 2. Eligibility flow chart for the study of cystoid macular edema
Figure 3A
Figure 3A. Change in visual acuity from baseline by cystoid edema and intraretinal fluid status
Figure 3B
Figure 3B. Mean visual acuity over time by cystoid edema and intraretinal fluid status
Figure 4A
Figure 4A. Change in total central retinal thickness from baseline by cystoid edema and intraretinal fluid status
Figure 4B
Figure 4B. Total central retinal thickness over time by cystoid edema and intraretinal fluid status
See this image and copyright information in PMC

References

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    1. Gass JDM. Current concepts concerning cystoid macular edema. In: Franklin RM, editor. Retina and vitreous: proceedings of the Symposium on Retina and Vitreous. Kugler; Amsterdam: 1993. pp. 295–297.
    1. CATT Research Group Ranibizumab and bevacizumab for neovascular age-related macular degeneration. N Engl J Med. 2011;364:1897–908. - PMC - PubMed
    1. CATT Research Group Ranibizumab and bevacizumab for treatment of neovascular age-related macular degeneration: two-year results. Ophthalmology. 2012;119:1388–98. - PMC - PubMed

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