title: Outer retinal tubulation in the comparison of age-related macular degeneration treatments trials (CATT).
abstract: OBJECTIVE
  To determine the prevalence of, risk factors for, and visual acuity (VA) correlations with outer retinal tubulation (ORT) seen on spectral-domain optical coherence tomography (SD OCT) in eyes with neovascular age-related macular degeneration (AMD) after anti-vascular endothelial growth factor (VEGF) therapy.
  
  
  METHODS
  Prospective cohort study within a randomized clinical trial.
  
  
  METHODS
  Patients with SD OCT images at weeks 56 and 104 in the Comparison of AMD Treatments Trials (CATT).
  
  
  METHODS
  Participants in the CATT were assigned randomly to ranibizumab (0.5 mg) or bevacizumab (1.25 mg) treatment and to a monthly or pro re nata (PRN) injection-dosing regimen. A subset of eyes was 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 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.
  
  
  METHODS
  Outer retinal tubulations.
  
  
  RESULTS
  Seven of 69 eyes (10.1%) at 56 weeks and 64 of 368 eyes (17.4%) at week 104 had ORTs. Absence of diabetes, poor VA, blocked fluorescence, geographic atrophy, greater lesion size, and presence of subretinal hyperreflective material at baseline were associated independently with greater risk of ORT at 104 weeks (P < 0.05). Neither drug nor dosing regimen were associated significantly with ORT. The mean VA of eyes with ORT at week 104 (58.5 Early Treatment Diabetic Retinopathy Study letters) was worse than the mean VA of eyes without ORT (68.8 letters; P < 0.0001).
  
  
  CONCLUSIONS
  At 2 years after initiation of anti-VEGF therapy for neovascular AMD, ORTs are present in a substantial proportion of eyes. We identified baseline features that independently predict ORTs. It is important to identify ORTs because eyes with ORTs have worse VA outcomes than those without this finding.
authors: Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina; Department of Ophthalmology, Asan Medical Center, University of Ulsan, Seoul, Korea.
authors: Joo Yong
authors: JY
authors: Lee
authors: Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
authors: Francisco A
authors: FA
authors: Folgar
authors: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Maureen G
authors: MG
authors: Maguire
authors: Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Gui-shuang
authors: GS
authors: Ying
authors: Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
authors: Cynthia A
authors: CA
authors: Toth
authors: Department of Ophthalmology, Cleveland Clinic, Cleveland, Ohio.
authors: Daniel F
authors: DF
authors: Martin
authors: Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina. Electronic address: glenn.jaffe@duke.edu.
authors: Glenn J
authors: GJ
authors: Jaffe
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D000069579:Ranibizumab; D012164:Retinal Diseases / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D055214:Retinal Photoreceptor Cell Outer Segment / Q000473:pathology*; D012307:Risk Factors; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069579:Ranibizumab