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Marco Nassisi, Yue Shi, Michael S Ip, Srinivas R. Sadda; QUANTITATIVE ASSESSMENT OF INTRARETINAL HYPERREFLECTIVE FOCI IN PATIENTS WITH INTERMEDIATE AGE-RELATED MACULAR DEGENERATION. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3247.
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The presence of intraretinal hyper-reflective foci (HRF) due to migrating retinal pigment epithelium (RPE) has already been associated with age related macular degeneration (AMD) progression. We retrospectively reviewed en-face OCT images of intermediate AMD patients to evaluate the correlation between HRF quantity and progression to advanced AMD after one year.
A series of 6x6 mm macular cube scans (Cirrus HD-OCT) from 114 eyes of 114 patients were reviewed. Five consecutive en-face slabs from the inner limiting membrane to the inner surface of RPE, each representing 20% of the retinal thickness, were analyzed after enhancing contrast with the instrument software. HRF were automatically segmented (and manually-refined) using ImageJ software and confirmed by inspection of corresponding B-Scans. The five slabs were combined and the area of HRF was measured in the whole image (HRFTOT), and in the central 3mm (HRF3mm) and 5mm (HRF5mm) areas (Figure). Inter-operator repeatability of HRF measurements was tested in 20 eyes. Overall results were correlated with the development of choroidal neovascularization (CNV) and/or RPE atrophy after one year of follow-up, using Spearman coefficients.
HRF measurements showed good inter-operator repeatability with intra-class correlation coefficients of 0.894 (95% confidence interval: 0.878-0.934), 0.873 (0.843-0.927) and 0.869 (0.841-0.931) for HRF3mm, HRF5mm and HRFTOT respectively. At baseline, 58 patients had presence of HRF (50.8%). Among the whole cohort, 9 patients developed CNV (7.9%) and 37 (32.4%) developed RPE atrophy after one year of follow-up. A good correlation was found between HRF measurements and progression to either RPE atrophy or CNV: R=0.610 (p<0.001) for HRF3mm, R=0.622 (p<0.001) for HRF5mm and R=0.614 (p<0.001) for HRFTOT. Correlations were still significant with progression to atrophy alone (0.545 (p<0.001), 0.560 (p<0.001) and 0.556 (p<0.001) for HRF3mm, HRF5mm and HRFTOT respectively), but not for progression to CNV alone, possibly due to the low event rate of CNV (i.e. underpowered).
The amount of HRF in patients with intermediate AMD correlated with the 1-year risk of AMD progression, in particular with the development of RPE atrophy. Quantification of macular HRF using en-face OCT may have a potential clinical use in evaluating patients’ prognosis.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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