PURPOSE To evaluate associations of morphologic features with 5-year visual acuity (VA) in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT). DESIGN Cohort study within a randomized clinical trial. PARTICIPANTS Participants in CATT. METHODS Eyes with age-related macular degeneration-associated choroidal neovascularization (CNV) and VA between 20/25 and 20/320 were eligible. Treatment was assigned randomly to ranibizumab or bevacizumab and to 3 dosing regimens for 2 years and was at the ophthalmologists' discretion thereafter. MAIN OUTCOME MEASURES Visual acuity, thickness and morphologic features on OCT, and lesion size and foveal composition on fundus photography (FP) and fluorescein angiography (FA). RESULTS Visual acuity and image gradings were available for 523 of 914 participants (57%) alive at 5 years. At 5 years, 60% of eyes had intraretinal fluid (IRF), 38% had subretinal fluid (SRF), 36% had subretinal pigment epithelium (RPE) fluid, and 66% had subretinal hyper-reflective material (SHRM). Mean (standard deviation) foveal center thickness was 148 μm (99) for retina, 5 μm (21) for SRF, 125 μm (107) for subretinal tissue complex, 11 μm (33) for SHRM, and 103 μm (95) for RPE + RPE elevation. The SHRM, thinner retina, greater CNV lesion area, and foveal center pathology (all P < 0.001) and IRF (P < 0.05) were independently associated with worse VA. Adjusted mean VA letters were 62 for no pathology in the foveal center; 61 for CNV, fluid, or hemorrhage; 65 for non-geographic atrophy (GA); 64 for nonfibrotic scar; 53 for GA; and 56 for fibrotic scar. Incidence or worsening of 8 pathologic features (foveal GA, foveal scar, foveal CNV, SHRM, foveal IRF, retinal thinning, CNV lesion area, and GA area) between years 2 and 5 was independently associated with greater loss of VA from years 2 to 5 and VA loss from baseline to year 5. CONCLUSIONS Associations between VA and morphologic features previously identified through year 1 were maintained or strengthened at year 5. New foveal scar, CNV, intraretinal fluid, SHRM and retinal thinning, development or worsening of foveal GA, and increased lesion size are important contributors to the VA decline from years 2 to 5. A significant need to develop therapies to address these adverse pathologic features remains.

中文翻译：

---

与年龄相关的黄斑变性治疗试验比较的第五年中的黄斑形态和视敏度。

目的在年龄相关性黄斑变性治疗试验（CATT）的比较中评估形态特征与5年视力（VA）的关联。设计一项随机临床试验中的队列研究。参加CATT的参与者。方法年龄相关性黄斑变性相关脉络膜新血管形成（CNV）和VA在20/25至20/320之间的眼睛是合格的。随机分配兰尼单抗或贝伐单抗治疗，并给予3种给药方案治疗2年，此后由眼科医生自行决定。主要观察指标OCT的视敏度，厚度和形态特征，眼底摄影（FP）和荧光素血管造影（FA）的病变大小和中央凹组成。结果914位5年存活的参与者中有523位（57％）有视力和图像分级。在5年时，60％的眼睛有视网膜内液（IRF），38％的眼睛具有视网膜下液（SRF），36％的眼睛具有视网膜下色素上皮（RPE）液，66％的眼睛具有视网膜下超反射材料（SHRM）。视网膜中央凹平均中心厚度（148微米（99）），SRF 5微米（21），视网膜下组织复合物125微米（107），SHRM 11微米（33）和103微米（95） RPE + RPE高程。SHRM，较薄的视网膜，较大的CNV病变面积和中央凹中心病变（均P <0.001）和IRF（P <0.05）均与较差的VA相关。调整后的平均VA字母为62，在中央凹中心无病变。61用于CNV，体液或出血; 非地理萎缩症（GA）为65；非纤维化疤痕为64；对于GA，为53；纤维化疤痕为56。8个病理特征（中央凹GA，中央凹疤痕，中央凹CNV，SHRM，