Giuseppe Casalino1, Francesco Bandello2, Usha Chakravarthy3. 1. Ophthalmology Macular Service Belfast Health and Social Care Trust and Centre for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom 2Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, It. 2. Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute University, Milan, Italy. 3. Ophthalmology Macular Service Belfast Health and Social Care Trust and Centre for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom.
Abstract
PURPOSE: To correlate presence of hyperreflective material (HRM) on spectral-domain optical coherence tomography (SD-OCT) with color fundus photography (CFP) in patients with different subtypes of neovascular age-related macular degeneration (n-AMD). METHODS: Retrospective assessments were made at baseline and months 1, 3, and 12 after initiation of treatment. At baseline, CFP images were graded for the presence of blood, fibrin and lipid exudates, and retinal angiograms for n-AMD subtype. At the four selected visits, SD-OCT scans were graded for HRM type (well-defined or undefined) and location (subretinal, intraretinal, and subretinal pigment epithelium [RPE]), integrity of RPE, ellipsoid zone, and external limiting membrane (ELM). RESULTS: A total of 121 eyes with active n-AMD from 117 patients were included. At baseline, undefined HRM was strongly associated with fibrin on CFP (χ2 = 39.87; P < 0.001). The overall prevalence of HRM decreased from 85.9% at baseline to 52.9% by month 12. From baseline to month 12, undefined HRM decreased (53.7% vs. 7.4%, respectively) and well-defined HRM increased (32.2% vs. 45.5%, respectively). Sub-RPE HRM, which was infrequent at baseline, increased up to 30.6% by month 12. At month 12, eyes with no HRM had the best mean final best-corrected visual acuity (BCVA), and those with undefined HRM the worst. Multivariate regression analysis showed that ELM disruption at both baseline and month 12 was a negative predictive factor for final BCVA (P = 0.001 and P < 0.001, respectively), whereas presence of subretinal fluid at month 12 and number of treatments were positive predictors for final BCVA (P = 0.007 and P = 0.041, respectively), but the covariates describing HRM did not reach statistical significance in these models. CONCLUSIONS: In eyes with n-AMD, location and morphology of HRM changed after anti-VEGF treatment, and differences were observed in the various choroidal neovascularization (CNV) subtypes. After anti-VEGF treatment, it was well-defined HRM in the sub-RPE space that was observed mostly.
PURPOSE: To correlate presence of hyperreflective material (HRM) on spectral-domain optical coherence tomography (SD-OCT) with color fundus photography (CFP) in patients with different subtypes of neovascular age-related macular degeneration (n-AMD). METHODS: Retrospective assessments were made at baseline and months 1, 3, and 12 after initiation of treatment. At baseline, CFP images were graded for the presence of blood, fibrin and lipid exudates, and retinal angiograms for n-AMD subtype. At the four selected visits, SD-OCT scans were graded for HRM type (well-defined or undefined) and location (subretinal, intraretinal, and subretinal pigment epithelium [RPE]), integrity of RPE, ellipsoid zone, and external limiting membrane (ELM). RESULTS: A total of 121 eyes with active n-AMD from 117 patients were included. At baseline, undefined HRM was strongly associated with fibrin on CFP (χ2 = 39.87; P < 0.001). The overall prevalence of HRM decreased from 85.9% at baseline to 52.9% by month 12. From baseline to month 12, undefined HRM decreased (53.7% vs. 7.4%, respectively) and well-defined HRM increased (32.2% vs. 45.5%, respectively). Sub-RPE HRM, which was infrequent at baseline, increased up to 30.6% by month 12. At month 12, eyes with no HRM had the best mean final best-corrected visual acuity (BCVA), and those with undefined HRM the worst. Multivariate regression analysis showed that ELM disruption at both baseline and month 12 was a negative predictive factor for final BCVA (P = 0.001 and P < 0.001, respectively), whereas presence of subretinal fluid at month 12 and number of treatments were positive predictors for final BCVA (P = 0.007 and P = 0.041, respectively), but the covariates describing HRM did not reach statistical significance in these models. CONCLUSIONS: In eyes with n-AMD, location and morphology of HRM changed after anti-VEGF treatment, and differences were observed in the various choroidal neovascularization (CNV) subtypes. After anti-VEGF treatment, it was well-defined HRM in the sub-RPE space that was observed mostly.
Authors: Rebecca N Evans; Barnaby C Reeves; Maureen G Maguire; Daniel F Martin; Alyson Muldrew; Tunde Peto; Chris Rogers; Usha Chakravarthy Journal: JAMA Ophthalmol Date: 2020-10-01 Impact factor: 7.389