SUBRETINAL HYPERREFLECTIVE MATERIAL IN WET AGE-RELATED MACULAR DEGENERATION AS MONITORING BIOMARKER FOR DISEASE ACTIVITY AND THE RESPONSE TO ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY

Abstract

Background and Objective: Hyper-reflective material can be considered as a surrogate Optical Coherence Tomography (OCT) biomarker in predicting disease activity and final visual outcome in patients with neovascular age-related macular degeneration (nARMD). The aim of this study was to assess the relationship between subretinal hyperreflective material (SHRM) morphological features, volume, response to anti-vascular endothelial growth factor (VEGF) therapy for choroidal neovascularization in wet age-related macular degeneration (AMD) and the best corrected visual acuity (BCVA).

Patients and Methods: The study is a prospective cohort. The study included 80 eyes with diagnosed wet form of AMD. The conducted study lasted for 1 year. 78 of the patients had finished the treatment regime. They were all previously untreated. A complete basic ophthalmological examination of both eyes was performed: BCVA was determined for the patient, intraocular pressure was measured according to the air puff method (non-contact air tonometry) and fundus examination. The diagnosis was confirmed using the non- invasive imaging method of OCT, DRI OCT Triton, Swept Source OCT device. OCT images and non-contrast angiography were also done in the region of the macula lutea of the retina. For measuring the SHRM weigh and high manual segmentation was performed. 

Results: SHRM at the entry of our study is a present finding in 47 respondents (58%). The mean value of visual acuity in the patients in our study ranged from 3.95 at week 0 to 0.9 at week 52 from the start of treatment. We had foveal localization at the beginning in 13 eyes, parafoveal in 12 eyes and perifoveal in 2, while in 20 eyes it was absent as an initial parameter. At the 6th month, the location of SHRM was foveal in 29 eyes, parafoveal in 8 eyes and perifoveal in 4 eyes, in 47 the finding was absent. In month 12, SHRM was foveal in 28 eyes, parafoveal in 18 and perifoveal in 4 eyes, absent in 28. In 6th month the mean BCVA was 6.90, which was up to 2.95 lines higher than the base line. In 12 months, 63/78 (80%) respondents did not have SHRM, and 16 (20%) of the respondents had. The mean final best corrected visual acuity in month 12 was 0.9. In 12 months in 61, (78%) of the respondents there was no SHRM border, in 4 (5%) there was, and it was unclear in 12 (16%) of the respondents.

Conclusion: SHRM presence and reflectivity at base line, which correlated with the BCVA as one of the newest retinal biomarkers in wet AMD forms, carries important information about the choroidal neovascularization (CNV) activity. SHRM reflectivity may be very useful for monitoring disease activity as well as important criteria for patient retreatment.