Subfoveal Fibrosis in Eyes With Neovascular Age-Related Macular Degeneration Treated With Intravitreal Ranibizumab

PURPOSE: To assess baseline and follow-up characteristics of choroidal neovascularization (CNV) lesions in age-related macular degeneration in relation to the development of subfoveal subretinal fibrosis. DESIGN: Retrospective, observational case series. METHODS: SETTINGS AND STUDY POPULATION: One hundred ninety-seven treatment-naive eyes in 197 patients with CNV in age-related macular degeneration without subfoveal fibrosis at first presentation who were, treated with ranibizumab in a pro re nata regimen. MAIN OUTCOME MEASURE: Subfoveal fibrosis at the conclusion follow-up of 24 months or fewer. RESULTS: The hazard ratio of any subfoveal fibrosis developing in eyes with predominantly classic CNV was 5.95 (95% confidence interval [CI], 3.25 to 10.90) compared with minimally classic and occult CNV, whereas the hazard ratio of fibrosis developing with foveal atrophy was 3.38 (95% CI, 1.47 to 7.81; mean follow-up, 1.80 years; 95% CI, 1.75 to 1.85 years). The hazard ratio of any fibrosis developing was 3.38 (95% CI, 1.10 to 10.38) in eyes with a baseline best-corrected visual acuity of 40 or worse using Early Treatment Diabetic Retinopathy Study letter scores, as compared with eyes with a baseline best-corrected visual acuity of 70 letters or more. An interval between diagnosis and treatment of 15 days or more was associated with a hazard ratio of any fibrosis developing of 2.24 (95% CI, 1.28 to 3.94) as compared with an interval of fewer than 15 days. Compared with eyes in which fibrosis did not develop, eyes in which prominent fibrosis or fibrosis developed with foveal atrophy lost 8.5 more Early Treatment Diabetic Retinopathy Study letters (95% CI, -1.0 to -15.9; P = .0242) and 10.3 more Early Treatment Diabetic Retinopathy Study letters (95% CI, -4.0 to -16.5; P = .0012), respectively. CONCLUSIONS: The development of subfoveal fibrosis in neovascular age-related macular degeneration was associated with predominantly classic CNV and poorer visual acuity at first presentation, a longer interval between diagnosis and treatment, and approximately 2 lines of additional visual loss at the conclusion follow-up. (C) 2013 by Elsevier Inc. All rights reserved.