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Variable response of subretinal hyperreflective material to anti-vascular endothelial growth factor classified with optical coherence tomography angiography

  • Retinal Disorders
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Abstract

Purpose

To evaluate the prognosis and response of neovascular age-related macular degeneration (AMD) to anti-vascular endothelial growth factor (VEGF), according to the components of subretinal hyperreflective material (SHRM) classified using optical coherence tomography angiography (OCTA), is the aim of this study.

Methods

We retrospectively studied 39 eyes of 39 consecutive patients with SHRM associated with exudative AMD, who underwent standard examination and multimodal imaging, including fundus photography, optical coherence tomography (OCT), and OCTA. We classified SHRM into type 2 neovascularization (NV), fibrosis, subretinal hyperreflective exudation (SHE), and hemorrhage using OCTA. If compound SHRM was found, components in the foveal center were considered. All patients except one with fibrosis received anti-VEGF treatment for more than 12 months. The best-corrected visual acuity (BCVA) values measured before treatment and at 3, 6, and 12 months after the first injection were compared according to the components of SHRM.

Results

Using OCTA, 11 eyes with type 2 NV showed abnormal blood flow and 1 eye with fibrosis showed strong surface projection. Both SHE and hemorrhage components showed projection artifact with no intrinsic flow. However, OCTA enabled eyes with SHE (17 eyes) to be distinguished from those with hemorrhage (10 eyes) because hemorrhage showed masking of choriocapillaris flow. Eyes with SHE showed a significant improvement in the mean logMAR BCVA as compared with the value at the baseline, which was sustained throughout the 12-month follow-up period (p < 0.05). In eyes with type 2 NV and hemorrhage, no significant difference in the mean BCVA values was observed at any follow-up time-point (all, p > 0.05).

Conclusion

OCTA was useful to noninvasively distinguish SHRM components. It may be important to consider the components of SHRM to predict the visual acuity in patients with AMD.

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Authors and Affiliations

  1. Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan

    Maiko Maruyama-Inoue, Shimpei Sato, Shin Yamane & Kazuaki Kadonosono

Authors
  1. Maiko Maruyama-Inoue
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  2. Shimpei Sato
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  3. Shin Yamane
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  4. Kazuaki Kadonosono
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Corresponding author

Correspondence to Maiko Maruyama-Inoue.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For retrospective study, formal consent is not required.

Informed consent

Opt-out consent method was chosen, approved by the institutional review board of Yokohama City University because no information identifying individual participants was involved in this article.

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Maruyama-Inoue, M., Sato, S., Yamane, S. et al. Variable response of subretinal hyperreflective material to anti-vascular endothelial growth factor classified with optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 256, 2089–2096 (2018). https://doi.org/10.1007/s00417-018-4121-7

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  • DOI: https://doi.org/10.1007/s00417-018-4121-7

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