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PROGNOSTIC VALUE OF SUBRETINAL HYPERREFLECTIVE MATERIAL IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION TREATED WITH BEVACIZUMAB

Pokroy, Russell, MD*; Mimouni, Michael, MD; Barayev, Edward, BSc; Segev, Fani, MD; Geffen, Noa, MD; Nemet, Arie, Y., MD; Segal, Ori, MD

doi: 10.1097/IAE.0000000000001748
Original Study: PDF Only

Purpose: To study the correlation between subretinal hyperreflective material (SHRM) seen on spectral domain optical coherence tomography at baseline and visual outcomes after intravitreal bevacizumab injection in neovascular age-related macular degeneration.

Methods: Consecutive patient charts with treatment-naive center-involved neovascular age-related macular degeneration treated with 3 monthly intravitreal bevacizumab's, continued as needed, from 2011 to 2014 were reviewed. Baseline spectral domain optical coherence tomography SHRM parameters (height, width, area, reflectivity, border definition, and homogeneity) and established optical coherence tomography biomarkers of neovascular activity (intraretinal fluid, subretinal fluid, retinal volume, central retinal thickness, and pigment epithelial detachment presence) were collected. These baseline parameters were correlated with visual acuity at baseline, 3 and 12 months.

Results: Seventy-three eyes of 73 patients, 47 (64.4%) having central SHRM at baseline, were studied. Mean age was 79.2 ± 8.9 years. Mean best-corrected visual acuity was 0.70 ± 0.57 logarithm of the minimum angle of resolution (20/100), 0.73 ± 0.55 (20/107), and 0.76 ± 0.63 (20/115) at baseline, 3 and 12 months, respectively. Baseline parameters with a significant predictive value of 12-month visual acuity by univariate analysis were presence of intraretinal fluid, presence of SHRM, highly reflective SHRM, well-defined SHRM borders, and thick SHRM. These parameters, with the exception of high reflectivity, were significant on multivariate regression analysis. The most predictive baseline parameter was well-defined SHRM borders.

Conclusion: This study supports the use of SHRM as a prognostic biomarker when interpreting optical coherence tomography in neovascular age-related macular degeneration. Baseline parameters predicting poorer vision 1 year after intravitreal bevacizumab treatment were as follows: presence of central SHRM, well-defined SHRM borders, intraretinal fluid, and thicker SHRM.

The following baseline parameters predicted poorer vision 1 year after treatment with bevacizumab for treatment-naive neovascular age-related macular degeneration: presence of central subretinal hyperreflective material, well-defined SHRM borders, intraretinal fluid, and thicker subretinal hyperreflective material.

*Department of Ophthalmology, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel;

Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel; and

Department of Ophthalmology, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Kfar Sava, Israel.

Reprint requests: Ori Segal, MD, Department of Ophthalmology, Meir Medical Center, Kfar Saba 44281, Israel; e-mail: orisegal@gmail.com

Presented in part at the Annual Israel Ophthalmic Society Meeting, Tel-Aviv, June 1, 2016.

None of the authors has any financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.