PMID- 35314388 OWN - NLM STAT- MEDLINE DCOM- 20220809 LR - 20220906 IS - 2468-6530 (Electronic) IS - 2468-6530 (Linking) VI - 6 IP - 8 DP - 2022 Aug TI - Long-term Retinal Morphology and Functional Associations in Treated Neovascular Age-Related Macular Degeneration: Findings from the Inhibition of VEGF in Age-Related Choroidal Neovascularisation Trial. PG - 664-675 LID - S2468-6530(22)00109-9 [pii] LID - 10.1016/j.oret.2022.03.010 [doi] AB - PURPOSE: To describe the frequency of long-term morphologic features and their relationships with visual function in participants who exited the Inhibition of VEGF in Age-Related Choroidal Neovascularisation (IVAN; ISRCTN92166560) trial. DESIGN: Multicenter cohort study up to 7 years after enrollment. PARTICIPANTS: Patients enrolled in the IVAN trial, excluding participants who died or withdrew during the trial. METHODS: Multimodal fundus images, best-corrected visual acuity (BCVA), and low-luminance visual acuity (LLVA) were obtained for a subset of 199 participants who attended a research visit. Clinical sites (n = 20) also provided all visual acuity and clinical information from usual care records for 532 participants and submitted the most recent color, OCT, and other fundus images for 468 participants to a reading center. MAIN OUTCOME MEASURES: Assessed the following from the most recent images: intralesional macular atrophy (ILMA) within the footprint of the neovascular lesion; hyperreflective material (HRM); intraretinal fluid (IRF); subretinal fluid (SRF); pigment epithelial detachment (PED); and disorganized retinal outer layers (DROLs). Cross-sectional relationships between morphologic features and BCVA/LLVA were estimated. RESULTS: Intralesional macular atrophy was present in 31.8% of the study eyes at IVAN exit (mean follow-up, 1.96 years) and 89.5% at the most recent imaging visit (mean follow-up, 6.18 years). Hyperreflective material, IRF, SRF, PED, and DROLs were present in 78.8%, 47.7%, 7.6%, 94.5%, and 55% of the study eyes, respectively. In the subset with complete imaging data, in eyes without DROL, the BCVA was worst in the thinnest outer fovea tertile (thinnest minus middle and thickest tertiles, -19.7 and -19.5 letters, respectively), whereas in eyes with DROL, the BCVA was worst in the thickest (thinnest and middle tertiles minus thickest, 12.5 and 12.2, respectively). Regression models showed that the presence of ILMA and HRM was independently associated with BCVA (22 letters worse [95% confidence interval CI, -11.2 to -32.8; P < 0.001] and 9.8 letters worse [95% CI, -0.1 to -19.4; P = 0.047], respectively). Subretinal fluid and foveal PED were associated with better BCVA (5.9 letters [95% CI, -7.9 to 19.7; P = 0.399] and 6.4 letters [95% CI, -1.1 to 14.0; P = 0.094], respectively). The model with LLVA was similar. A sensitivity analysis involving the entire eligible cohort yielded similar estimates. CONCLUSIONS: Macular atrophy and HRM were common after 7 years of follow-up and strongly associated with visual outcomes. CI - Crown Copyright (c) 2022. Published by Elsevier Inc. All rights reserved. FAU - Peto, Tunde AU - Peto T AD - Queen's University of Belfast, Royal Victoria Hospital, Belfast, Ireland. FAU - Evans, Rebecca N AU - Evans RN AD - Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom. FAU - Reeves, Barnaby C AU - Reeves BC AD - Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom. FAU - Harding, Simon AU - Harding S AD - Department of Eye and Vision Science, University of Liverpool and St Paul's Eye Unit, Liverpool University Hospitals National Health Service Foundation Trust, Members of Liverpool Health Partners, Liverpool, United Kingdom. FAU - Madhusudhan, Savita AU - Madhusudhan S AD - Department of Eye and Vision Science, University of Liverpool and St Paul's Eye Unit, Liverpool University Hospitals National Health Service Foundation Trust, Members of Liverpool Health Partners, Liverpool, United Kingdom. FAU - Lotery, Andrew AU - Lotery A AD - Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom. FAU - Downes, Susan AU - Downes S AD - University Hospitals National Health Service Trust, Oxford, United Kingdom. FAU - Balaskas, Konstantinos AU - Balaskas K AD - Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom. FAU - Bailey, Clare C AU - Bailey CC AD - Department of Ophthalmology, University Hospitals Bristol National Health Service Foundation Trust, Bristol, United Kingdom. FAU - Foss, Alexander AU - Foss A AD - Department of Ophthalmology, Nottingham University Hospitals, Nottingham, United Kingdom. FAU - Ghanchi, Faruque AU - Ghanchi F AD - Department of Ophthalmology, Bradford Royal Infirmary, Bradford, West Yorkshire, United Kingdom. FAU - Yang, Yit AU - Yang Y AD - Department of Ophthalmology, New Cross Hospital, The Royal Wolverhampton National Health Service Trust, Wolverhampton, United Kingdom. FAU - Phillips, Dawn AU - Phillips D AD - Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom. FAU - Rogers, Chris A AU - Rogers CA AD - Bristol Trials Centre, Bristol Medical School, University of Bristol, Bristol, United Kingdom. FAU - Muldrew, Alyson AU - Muldrew A AD - Queen's University of Belfast, Royal Victoria Hospital, Belfast, Ireland. FAU - Hamill, Barbra AU - Hamill B AD - Queen's University of Belfast, Royal Victoria Hospital, Belfast, Ireland. FAU - Chakravarthy, Usha AU - Chakravarthy U AD - Queen's University of Belfast, Royal Victoria Hospital, Belfast, Ireland. Electronic address: u.chakravarthy@qub.ac.uk. LA - eng GR - 07/36/01/DH_/Department of Health/United Kingdom GR - 07/36/501/DH_/Department of Health/United Kingdom PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20220318 PL - United States TA - Ophthalmol Retina JT - Ophthalmology. Retina JID - 101695048 RN - 0 (Angiogenesis Inhibitors) RN - 0 (Vascular Endothelial Growth Factor A) RN - ZL1R02VT79 (Ranibizumab) SB - IM MH - Angiogenesis Inhibitors/therapeutic use MH - Atrophy/drug therapy MH - *Choroidal Neovascularization/diagnosis/drug therapy MH - Cohort Studies MH - Humans MH - *Macular Degeneration/drug therapy MH - Ranibizumab/therapeutic use MH - *Retinal Detachment MH - Tomography, Optical Coherence MH - Vascular Endothelial Growth Factor A EDAT- 2022/03/23 06:00 MHDA- 2022/08/10 06:00 CRDT- 2022/03/22 05:35 PHST- 2022/02/06 00:00 [received] PHST- 2022/03/08 00:00 [revised] PHST- 2022/03/11 00:00 [accepted] PHST- 2022/03/23 06:00 [pubmed] PHST- 2022/08/10 06:00 [medline] PHST- 2022/03/22 05:35 [entrez] AID - S2468-6530(22)00109-9 [pii] AID - 10.1016/j.oret.2022.03.010 [doi] PST - ppublish SO - Ophthalmol Retina. 2022 Aug;6(8):664-675. doi: 10.1016/j.oret.2022.03.010. Epub 2022 Mar 18.