Changes in Neovascular Lesion Hyperreflectivity After Anti-VEGF Treatment in Age-Related Macular Degeneration: An Integrated Multimodal Imaging Analysis

Abstract

Citation: Casalino G, Bandello F, Chakravarthy U. Changes in neovascular lesion hyperreflectivity after anti-VEGF treatment in age-related macular degeneration: an integrated multimodal imaging analysis. Invest Ophthalmol Vis Sci. 2016;57:OCT288-OCT298. DOI:10.1167/iovs.15-18753 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 (v 2 ¼ 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 ¼ 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 ¼ 0.007 and P ¼ 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.

Swept‐source optical coherence tomography angiography features of sub‐retinal fibrosis in neovascular age‐related macular degeneration

“…In our series, increasing SHRM thickness, when centre‐involving, adversely impacted VA in the linear regression. Thickness and texture of SHRM on OCT have previously been shown to affect visual prognosis . Casalino et al .…”

“…The well‐defined variant of SHRM was exclusively observed in our case series and more likely represents organized, fibrotic tissue. This supports the observation that anti‐VEGF treatment induces a maturation of neovascular complexes towards an organized tissue in which hyper‐reflectivity increases over time …”

“…Subretinal hyper‐reflective material (SHRM) is a novel term commonly used in the literature to describe the appearance on optical coherence tomography (OCT) of diverse pathological material accruing under the retina in the course of nAMD. Subretinal fibrosis is a common constituent of SHRM …”

Stereotactic radiotherapy in neovascular age-related macular degeneration

“…[31,32] The first retinal layer to be affected by breakdown of the outer blood-retinal barrier is the OPS layer as well as the neighboring ellipsoid zone, which is also referred as the photoreceptor inner segment/outer segment (IS/OS) layer. Accumulation of subretinal fluid leads to detachment of the neurosensory retina and functional impairment of the photoreceptors.…”

Features of optical coherence tomography predictive of choroidal neovascularisation treatment response in pathological myopia in association with fluorescein angiography

“…We speculate that fluid from the active CNV resulted in the alteration of the optical reflectivity at the CNV margin, eventually leading to an obscure and fuzzy appearance, despite the lack of an apparent fluid space on OCT. Another possibility is the role of fibrin on the appearance of ill-defined subretinal hyper-reflective material. A recent study by Casalino et al 22 suggested that ill-defined hyper-reflective material seen in patients with neovascular AMD is correlated with fibrin on FP, and that the border of hyper-reflective material became much clearer after receiving anti-VEGF treatment. Using OCT, our study has provided additional guidelines for the treatment of myopic CNV, and that the fuzzy margin of the myopic CNV lesion on OCT examination was significantly correlated with active leakage on FA.…”