Abstract
Purpose :
Subretinal hyperreflective material (SHRM) in eyes with exudative neovascular age-related macular degeneration (AMD) treated with anti-vascular endothelial growth factor (VEGF) may gradually turn from macular neovascularization (MNV) type 2 into type 1 appearance on OCT. We here aimed to study the impact of this transformation on functional and morphological outcomes.
Methods :
Data for this post-hoc sub-analysis emerged from a 12-month, randomized, open label, multicenter study comparing the efficacy of Ranibizumab pro re nata versus Aflibercept bimonthly intravitreal injections in treatment-naïve patients newly diagnosed with exudative neovascular AMD (SALT). Imaging comprised fluorescein angiography, color fundus photography and autofluorescence at baseline and month 12, and monthly SDOCT (Spectralis SDOCT, Cirrus HDOCT). 203 eyes of 203 study patients with SHRM on SDOCT at baseline were included. Two certified graders blinded to functional data assigned each eye to one of the following 4 categories: (A) SHRM remains present with type 2 appearance, (B) SHRM partially transformed into type 1 appearance, (C) SHRM completely transformed into type 1 appearance, (D) SHRM disappeared. The area of decreased autofluorescence was additionally evaluated at baseline and month 12.
Results :
Analyses of variances (ANOVAs) found a significant effect of the factor SHRM CATEGORY (levels A (n=136), B (n=18), C (n=23), D (n=26)) on the change of BCVA at 3 months compared to baseline (F[3,196]=6.86;p<0.001): Post-hoc t-tests were significant (p<0.05) for comparisons of SHRM Category A (mean 3.8 ETDRS letters) with B (9.9), C (10.7) and D(10.8). At 12 months (F[3,196]=4,85;p=0.003) post-hoc t-tests found a significant difference between SHRM Category A (4.6) only versus C (15.1) and D (10.6), but not B (8.4). For the area of decreased autofluorescence at 12 months, we also found a significant effect (F[3,170]=4.41;p=0.005): Post-hoc t-tests showed significant differences between Category A (mean area 1.076 mm2) versus B (0.079) and C (0.077) but not D (0.385).
Conclusions :
Eyes with transformation of SHRM from type 2 into type 1 appearance on the course of therapy had a significantly higher mean improvement of visual acuity 3 and 12 months after initiation of therapy and showed a smaller area of decreased auto-fluorescence after 12 months.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.