Outcomes of Eyes with Lesions Composed of >50% Blood in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)

Objective To compare baseline characteristics, treatment frequency, visual acuity (VA), and morphologic outcomes of eyes with >50% of the lesion composed of blood (B50 group) versus all other eyes (Other group) enrolled in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). Design Prospective cohort study within a multicenter randomized clinical trial. Participants CATT patients with neovascular age-related macular degeneration (AMD). Methods Treatment for the study eye was assigned randomly to either ranibizumab or bevacizumab and to 3 different dosing regimens over a 2-year period. Reading center graders evaluated baseline and follow-up morphology in color fundus photographs, fluorescein angiography (FA), and optical coherence tomography (OCT). Masked examiners tested VA. Main Outcome Measures Morphologic features and VA at 1 and 2 years. Results The B50 group consisted of 84 of 1185 (7.1%) patients enrolled in CATT. Baseline lesion characteristics differed between groups. In the B50 group, choroidal neovascularization size was smaller (0.73 vs 1.83 disc areas [DA]; P P P  = 0.02), and mean VA was worse (56.0 vs 60.9 letters; P  = 0.002). Increases in mean VA were similar in the B50 and Other groups at 1 year (+9.3 vs +7.2 letters; P  = 0.22) and at 2 years (9.0 vs 6.1 letters; P  = 0.17). Eyes treated PRN received a similar number of injections in the 2 groups (12.2 vs 13.4; P  = 0.27). Mean lesion size in the B50 group decreased by 1.2 DA at both 1 and 2 years (primarily owing to resolution of hemorrhage) and increased in the Other group by 0.33 DA at 1 year and 0.91 DA at 2 years ( P Conclusions In CATT, the B50 group had a visual prognosis similar to the Other group. Lesion size decreased markedly through 2 years. Eyes like those enrolled in CATT with neovascular AMD lesions composed of >50% blood can be managed similarly to those with less or no blood.