Outer Retinal Tubulation in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)

Abstract

Purpose To determine the prevalence of, risk factors for, and visual acuity correlations with outer retinal tubulation (ORT) seen on spectral domain optical coherence tomography (SD-OCT) in eyes with neovascular age-related macular degeneration (AMD) following anti-VEGF therapy. Design Prospective cohort study within a randomized clinical trial. Participants Patients with SD-OCT images at Week 56 and 104 in the Comparison of AMD Treatment Trials (CATT). Methods Participants in the CATT were randomly assigned to ranibizumab (0.5mg) or bevacizumab (1.25mg) treatment and to a monthly or PRN injection-dosing regimen. A subset of eyes were imaged with SD-OCT beginning at Week 56. Cirrus 512×128 or Spectralis 20°×20° volume cube scan protocols were used to acquire SD-OCT images. Two independent readers at the CATT OCT Reading Center graded scans, and a senior reader arbitrated discrepant grades. The prevalence of ORT, identified as a tubular structures seen on at least 3 consecutive Cirrus B scans or 2 consecutive Spectralis B scans, was determined. The associations of patient-specific and ocular features at baseline and follow-up with ORT were evaluated by univariate and multivariate analyses. Main Outcome Measures Outer retinal tubulations. Results Seven of 69 eyes (10.1%) at 56 weeks and 64 of 368 (17.4%) eyes at week 104 had ORTs. Absence of diabetes, poor visual acuity (VA), blocked fluorescence, geographic atrophy (GA), greater lesion size, and presence of subretinal hyper-reflective material at baseline were independently associated with greater risk of ORT at 104 weeks (p<0.05). Neither drug nor dosing regimen were significantly associated with ORT. The mean VA of eyes with ORT at week 104 (58.5 ETDRS letters) was worse than the mean VA of eyes without ORT (68.8 letters; p<0.0001). Conclusion At 2 years after initiation of anti-VEGF therapy for neovascular AMD, ORTs are present in a substantial proportion of eyes. We have identified baseline features that independently predict ORTs. It is important to identify ORTs, since eyes with ORTs have worse visual acuity outcomes than those without this finding.

Outer retinal tubulations response to anti-VEGF treatment

“…Although our data are too small to make a definite conclusion, we demonstrated that not all ORTs are stable but instead can significantly change over time. This finding is also in agreement with previous results of the CATT study;7 although seven eyes showed ORTs at week 56, only one eye had persistent ORTs at week 104. This could suggest that some ORTs may be vascular in nature and may respond to anti-VEGF treatment, while other ORTs could alternatively be coincidental in nature.…”

“…This study confirms results from previous investigators1 2 7 that ORTs are associated with worse visual acuity at baseline and worse prognosis due to their association with disciform scars. The trend is clear that eyes with ORTs have lower visual acuity than eyes with no ORTs, and this is supported by the integrity of the subfoveal ELM where we found that 94% of eyes with ORTs had disrupted ELM.…”

Peripheral retinal function assessed with 30-Hz flicker seems to improve after treatment with Lucentis in patients with diabetic macular oedema

“…It has been speculated that it is possible to misinterpret a degeneration of photoreceptors as a remaining macular oedema [21]. According to this, we may have treated a dry macula at the second injection.…”

Optical Coherence Tomography Predictors of Risk for Progression to Non-Neovascular Atrophic Age-Related Macular Degeneration

“…As previously reported, the term IRF was retained because it was not possible to distinguish outer retinal tubulations without hyperreflective border from hyporeflective cystoid structures originating from fluid leakage. 34 Qualitative SDOCT variables that constituted rare findings – namely serous pigment epithelium detachment and foveal findings – were excluded from this analysis. Also, haze over RPE elevation was not included in this analysis because it occurred over all drusen as a result of the effect of beam entry position on the reflectivity of the Henle Fiber Layer.…”