Abstract
Purpose :
Subretinal transient hyporeflectivity (STHR) is a novel optical coherence tomography (OCT) finding in age-related macular degeneration (AMD). We described the prevalence of STHR in exudative neovascular AMD (nAMD) and treatment response to aflibercept loading phase.
Methods :
Treatment-naïve nAMD patients who completed a loading phase of aflibercept were investigated. OCT scans captured at baseline and after the loading phase were graded for presence of STHR, defined as a small, well-defined, round, subretinal, hyporeflective lesion, delimited between the ellipsoid zone and the retinal pigment epithelium/Bruch membrane complex. Other OCT parameters recorded were macular neovascularisation (MNV) subtypes, location of retinal fluids (intraretinal fluid, IRF, and subretinal fluid, SRF), central retinal thickness (CRT) and central choroidal thickness (CCT). Response was defined as absence of IRF and SRF. Factors associated with completely resolved STHR versus persistent STHR post-loading phase were compared.
Results :
1074 eyes of 1002 patients were included. STHR was observed in 39 eyes of 39 patients, with an estimated prevalence of 3.63% (95% CI 2.59-4.93%). 20 eyes were associated with type 1 MNV (51%), 14 with type 2 (36%), and 5 with type 3 (13%). At baseline, a total of 171 STHR lesions were present, ranging between 1-22 per eye. 9 eyes (23%) had single STHR while 30 eyes (77%) showed multiple STHR. STHR was located extrafoveally in all eyes and two eyes (5.1%) had STHR also in the foveal region.
The total number of STHR reduced significantly after the loading phase to 84 (p =.006). Complete disappearance of STHR was seen in 24 eyes (62%) and persistent STHR in the rest (15/39, 38%, p =.237). No statistically significant differences were found in baseline characteristics (CRT, CCT, presence of fluid subtypes, MNV subtypes) between eyes with resolved and persistent STHR. In eyes with IRF or SRF at baseline, the rates of resolution of STHR were higher in eyes that showed absence of IRF or SRF respectively after the loading phase (p =.046).
Conclusions :
Our findings suggest that STHR may represent a marker of low-grade exudation in nAMD eyes, with good response to aflibercept loading phase.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.