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Clinical Trials |

Incident Choroidal Neovascularization in Fellow Eyes of Patients With Unilateral Subfoveal Choroidal Neovascularization Secondary to Age-Related Macular Degeneration:  SST Report No. 20 From the Submacular Surgery Trials Research Group

Arch Ophthalmol. 2007;125(10):1323-1330. doi:10.1001/archopht.125.10.1323.
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Objective  To describe incident choroidal neovascular lesions in fellow eyes of participants in the Submacular Surgery Trials who had age-related macular degeneration (AMD).

Methods  Review of baseline fluorescein angiograms confirmed the absence of neovascular AMD in fellow eyes of 364 participants at risk. Subjects were eligible for a minimum of 2 years of follow-up with angiograms of eyes at risk reevaluated to estimate incidence rates of choroidal neovascularization (CNV) and to characterize these lesions.

Main Outcome Measures  Incidence of CNV during follow-up, characteristics of the incident lesion (composition, size, and location), and visual acuity at the time of incidence.

Results  Incident lesions were confirmed in 98 fellow eyes of participants, yielding 2- and 4-year cumulative incidence rates of 22% and 37%. Incident lesions were predominantly CNV in 87 fellow eyes (90%), extrafoveal in 29 fellow eyes (30%), and juxtafoveal in 9 fellow eyes (9%). Occult without classic CNV lesions were found in 64 eyes (67%), minimally classic CNV and predominantly classic CNV lesions in 12 eyes (13%) each, and predominantly blood lesions in 4 eyes (4%). Nearly two-thirds of all incident lesions were 3 disc areas or smaller in size. Median visual acuity decreased from 20/25 at baseline to 20/250 at the 4-year follow-up in fellow eyes with incident CNV.

Conclusions and Application to Clinical Practice  Frequent angiographic follow-up of fellow eyes at risk for CNV may lead to earlier detection and treatment of neovascular AMD and better visual acuity outcomes.

Trial Registration  clinicaltrials.gov Identifier: LOCATOR="http://clinicaltrials.gov/show/NCT00000150">NCT00000150

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Figure 1.

Cumulative percentage of all fellow eyes that had incident choroidal neovascularization (CNV) by follow-up examination time. Solid line indicates estimated percentage; bars, 95% confidence intervals. Number of fellow eyes at risk at each examination time, number of eyes with incident CNV observed at that examination, and number censored following that examination are shown below the horizontal axis.

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eFigure 1.

Cumulative percentage of fellow eyes in each Submacular Surgery Trials (SST) group that had incident choroidal neovascularization (CNV) by follow-up examination time. Solid line indicates fellow eyes of patients whose study eyes had predominantly hemorrhagic lesions at enrollment in the SST; broken line, fellow eyes of patients whose study eyes had predominantly CNV at time of SST enrollment. Numbers of fellow eyes at risk at each examination time, numbers of eyes with incident CNV observed at that examination, and numbers censored following that examination are shown below the horizontal axis.

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Figure 2.

Characteristics of incident choroidal neovascularization (CNV) in fellow eyes by year of follow-up when first observed. Each bar represents 100% of the incident cases identified during each year; the number of incident cases during the year that could be classified for each feature is shown at the top of each bar. A, Lesion location by year (1 case indeterminate). B, Lesion composition by year (3 cases indeterminate). “Other” includes cases that are predominantly blood or scar. C, Lesion size by year (2 cases indeterminate). D, Combination of lesion location, composition, and size (4 cases indeterminate). MPS indicates Macular Photocoagulation Study; DAs, disc areas.

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eFigure 2.

Median visual acuity in fellow eyes by presence or absence of choroidal neovascularization (CNV) and foveal geographic atrophy (GA). Open circles indicate fellow eyes free of CNV and foveal GA at baseline in whom no CNV developed during follow-up; solid circles, fellow eyes free of CNV and foveal GA at baseline in whom CNV developed over time; and solid squares, fellow eyes with neovascular age-related macular degeneration at baseline and throughout follow-up.

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