http://www.evrs.eu/medias/2006/congress/Incident-Choroidal-Neovascular-Lesions-in-the-Fellow-Eyes-of-Participants-with-Unilateral-Neovascular-AMD-during-the-Submacular-Surgery-Trials.swf

Sharon D. Solomon, MD (Baltimore, MD), Joan L. Jefferys, ScM (Baltimore, MD), Barbara S. Hawkins, PhD (Baltimore, MD), Susan B. Bressler, MD (Baltimore, MD), SST Research Group

PURPOSE:

Protocol fluorescein angiograms (FA) in SST participants included FE images at baseline, 3, 6, and 12 months after enrollment and annually thereafter. This report describes the incident CNV lesions that occurred in the FEs of SST AMD participants that were documented to have non-neovascular AMD at study entry and who were being monitored prospectively with FA.

METHODS:

Participants had new subfoveal CNV (Group N) or predominantly hemorrhagic CNV (group B). Baseline FA, read by masked graders at the Wilmer Reading Center (WRC), confirmed absence of neovascular AMD in the FE (non-study eye). The SST database included 233 Group N and 165 Group B participants at risk of incident CNV in the FE. All patients were eligible for a minimum of 2 years of follow-up. Initial WRC gradings identified 122 FEs (85 Group N and 37 Group B) as developing incident CNV. These images were re-evaluated to describe lesion location, size, and composition at the incident visit.

RESULTS:

98 of the 122 eyes initially catalogued as incident CNV were confirmed during this reassessment. Longer follow-up was available in Group N than Group B:136 (60%) of Group N and 79 (49%) of Group B FEs at risk of CNV completed at least 3 years of follow-up. Other than different incidence rates (ie. 25% in Group N and 17% in Group B at 24 months), the lesion characteristics were similar regardless of SST group. Lesions were predominantly CNV in 87 (89%), extrafoveal in 29 (30%) and juxtafoveal in 9 (9%) of FEs. Occult without classic CNV lesions were found in 64 (65%, among which 1/3 had blood), predominantly classic in 12 (12%), minimally classic in 12 (12%), and predominantly blood in 4 (4%). Nearly 2/3 of all lesions were =?3 disc areas (DA), with a median GLD of 3160 um. Symmetry between study eye (SE) and FE was poor: in Group N, classic CNV was present in 97% of SEs vs. 25% of incident FEs;in Group B, predominantly blood lesions were present in 89% of
SEs vs 7% of the incident FEs.

CONCLUSION:

A review of incident CNV in the FEs of SST AMD participants found the majority were occult with no classic, small (=?3 MPS DA), and many were not subfoveal. Careful and frequent (every 3-6 months) angiographic follow-up of FEs at risk may lead to earlier detection and treatment of neovascular AMD and ultimately a better visual prognosis for these eyes.