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Obaid Kousha, Usama Kanj, Sergio Pagliarini; Subretinal hyperreflective material and flecks in actively treated nAMD with or without classic features of disease reactivation. Invest. Ophthalmol. Vis. Sci. 2017;58(8):398.
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Spectral-domain optical coherence tomography (SD-OCT) features of choroidal neovascularization (CNV) include classical findings such as intra-retinal fluid (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED) and features like subretinal hyper-reflective materials (SHRM) and intra-retinal flecks. Recognizing SHRM and flecks may allow prompt recognition of active neovascular age-related macular degeneration (nAMD) when classical features are unchanged or absent. We aimed to ascertain the prevalence of SHRM and flecks in eyes actively treated for nAMD, and to determine the relationship between the classical features of nAMD with the SHRM and flecks.
In this cross-sectional study, we assessed the two most recent Spectralis SD-OCT scans of eyes on treat and extend regime of intravitreal anti-vascular endothelial growth factor injection for nAMD. The OCT findings were divided into classical signs and morphological features of SHRM suggestive of CNV activity (intra-retinal flecks and lower reflectivity SHRM with undefined boundaries (LRUnDB)), stability (higher reflectivity SHRM with well-defined boundaries (HRWDB)) or ambivalent features like higher reflectivity SHRM with undefined boundaries (HRUnDB) or lower reflectivity SHRM with well-defined boundaries (LRWDB). The PED was subdivided into predominantly serous, fibrovascular (FV) or irregular shallow retinal pigment epithelial elevation (RPEE). Increased CNV activity was defined as increased IRF/SRF/Serous PED on point by point comparison with the previous OCT.
237 eyes (203 patients) were included in the study, 27 of which were in the loading phase. The prevalences were IRF 25%, SRF 37%,, serous PED 19%, FVPED 62%, RPEE 12%, flecks 31%, LRUnDB 18%, LRWDB 45%, HRUnDB 0.4% and HRWDB 9%.IRF and/or SRF and/or serous PED moderately correlated with Flecks and LRUnDB with correlation coefficient r = 0.49* and 0.40* respectively. Flecks and LRUnDB were negatively correlated with FVPED and/or RPEE; r = -0.44* and -0.39* respectively. Increased IRF/SRF/Serous PED requiring change of management had significantly higher LRUnDB; 40% vs 10%, χ2 (1, n = 81) = 7.13, p-value <0.01.* = p-value <0.001
LRUnDB and flecks, common finding in nAMD, are correlated with increased CNV activity. Therefore, based on the OCT findings, these eyes may be selected for more aggressive treatment.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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