当前位置： SCI文献检索 > JAMA Ophthalmology期刊下所有文献 > Sustained visual acuity loss in the comparison of age-related macular degeneration treatments trials.

Sustained visual acuity loss in the comparison of age-related macular degeneration treatments trials.

Abstract：

IMPORTANCE:Although anti-vascular endothelial growth factor treatment of neovascular age-related macular degeneration (AMD) results in improved vision overall, loss of substantial vision can occur. Understanding the processes that lead to loss of vision may lead to preventive strategies. OBJECTIVE:To determine the incidence, characteristics, causes, and baseline predictors of sustained visual acuity loss after 2 years of treatment with ranibizumab or bevacizumab for neovascular AMD. DESIGN, SETTING, AND PARTICIPANTS:A cohort study within a randomized clinical trial of participants in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). INTERVENTIONS:Participants were randomly assigned to treatment with ranibizumab or bevacizumab and to 2 years of monthly or as needed injections or monthly injections for 1 year and as needed injections the following year. MAIN OUTCOMES AND MEASURES:Sustained visual acuity loss, defined as loss of 15 or more letters from baseline at weeks 88 and 104. RESULTS:Among 1030 participants, 61 eyes (5.9%) developed sustained visual acuity loss in 2 years. Within this group, visual acuity decreased gradually over time, with a mean decrease of 2, 19, and 33 letters from baseline at 4 weeks, 1 year, and 2 years, respectively. At 2 years, eyes with sustained visual acuity loss had more scarring (60.0% vs 41.4%, P = .007), more geographic atrophy (GA) (31.6% vs 20.7%, P = .004), larger lesions (16 vs 8 mm2, P < .001), and higher proportions of intraretinal fluid (82.5% vs 51.0%, P < .001), subretinal hyperreflective material (84.5% vs 44.2%, P < .001), retinal thinning (43.3% vs 23.0%, P < .001), and thickening (20.0% vs 12.1%, P < .001). Likely causes of sustained visual acuity loss included foveal scarring (44.3%), pigmentary abnormalities (27.9%), and foveal GA (11.5%). Baseline factors independently associated with a higher incidence of sustained visual acuity loss were the presence of nonfoveal GA (odds ratio [OR], 2.86; 95% CI, 1.35-6.08; P = .006), larger area of choroidal neovascularization (OR for a >4-disc area vs ≤1-disc area, 3.91; 95% CI, 1.70-9.03; P = .007), and bevacizumab treatment (OR, 1.83; 95% CI, 1.07-3.14; P = .03). CONCLUSIONS AND RELEVANCE:Sustained visual acuity loss was relatively rare in CATT. The development of foveal scar, pigmentary abnormalities, or GA contributed to most of the sustained visual acuity loss. Risk was 3% higher among eyes treated with bevacizumab. Treatment that targeted the prevention of scarring or GA may improve vision outcomes. TRIAL REGISTRATION:clinicaltrials.gov Identifier: NCT00593450.

journal_name

JAMA Ophthalmol

journal_title

JAMA ophthalmology

authors

Ying GS,Kim BJ,Maguire MG,Huang J,Daniel E,Jaffe GJ,Grunwald JE,Blinder KJ,Flaxel CJ,Rahhal F,Regillo C,Martin DF,CATT Research Group.

doi

10.1001/jamaophthalmol.2014.1019

subject

Has Abstract

pub_date

2014-08-01 00:00:00

pages

915-21

issue

eissn

2168-6165

issn

2168-6173

pii

1874719

journal_volume

132

pub_type

杂志文章,随机对照试验

在线工具

Sustained visual acuity loss in the comparison of age-related macular degeneration treatments trials.