Subretinal Hyperreflective Material (SHRM) as biomarker of activity in Exudative and Non- exudative inflammatory choroidal neovascularization

ABSTRACT

Aim

To analyze the structural features and therapeutic response in clinical and subclinical inflammatory choroidal neovascularization (i-CNV) detected inside subretinal hyperreflective material (SHRM) using swept-source optical coherence tomography (SS-OCT) and SS-OCT angiography (SS-OCTA).

Methods

In this prospective interventional study, subjects with quiescent posterior uveitis presenting with SHRM on SS-OCT and CNV network on SS-OCTA were included. Subjects with intraretinal fluid/subretinal fluid (IRF/SRF) received intravitreal antivascular endothelial growth factor (anti-VEGF) injections, while those with no IRF/SRF either received treatment or observation for 6 months until they developed IRF/SRF or decrease in best-corrected visual acuity (BCVA)/metamorphopsia. Serial comparisons included SHRM width and height and intrinsic flow signal on OCTA.

Results

28 eyes of 22 subjects (12 males; mean age: 29.52 ± 12.56 years) were evaluated. Subjects with IRF/SRF at baseline (n = 6 eyes; termed as exudative iCNVs) receiving treatment showed significant improvement in BCVA (p = .017), SHRM width/height and flow signal (p < .05). Among eyes with no IRF/SRF (n = 22; termed as non-exudative iCNVs), 7 received treatment and showed significant improvement in SHRM parameters and BCVA (p < .05). 4/15(26.67%) eyes that received no treatment developed IRF/SRF upon 6-month follow-up.

Conclusion

SHRM may act as a useful biomarker to monitor activity and response to therapy in eyes with iCNV.

KEYWORDS:

• Optical coherence tomography angiography
• choroidal neovascularization
• CNV
• subclinical CNV
• subretinal hyper-reflective material
• posterior uveitis
• anti-VEGF

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Precis

Patients with posterior uveitis and the presence of subretinal hyperreflective material and choroidal neovascular network on retinal imaging were followed up for 6 months. Eyes that received no treatment were at risk of developing exudation and vision loss, whereas eyes receiving treatment showed favorable anatomical outcomes.

Additional information

Funding

The author(s) reported that there is no funding associated with the work featured in this article.