Subretinal transient hyporeflectivity in neovascular age-related macular degeneration and its response to a loading phase of aflibercept: PRECISE report 4

• Published in: Eye (London) 2024-09, Vol.38 (13), p.2596-2602
• Main Authors: Montesel, Andrea, Pakeer Muhammed, Raheeba, Chandak, Swati, Kazantzis, Dimitrios, Thottarath, Sridevi, Chandra, Shruti, Chong, Victor, Burton, Benjamin J. L., Menon, Geeta, Pearce, Ian, McKibbin, Martin, Kotagiri, Ajay, Talks, James, Grabowska, Anna, Ghanchi, Faruque, Gale, Richard, Giani, Andrea, Yamaguchi, Taffeta Ching Ning, Sivaprasad, Sobha
• Format: Article
• Language: English
• Subjects: 692/308/53/2422; 692/53/2422; Age; Aged; Aged, 80 and over; Angiogenesis Inhibitors - therapeutic use; Epithelium; Eye; Female; Fluorescein Angiography - methods; Humans; Intravitreal Injections; Laboratory Medicine; Macular degeneration; Male; Medicine; Medicine & Public Health; Ophthalmology; Pharmaceutical Sciences/Technology; Receptors, Vascular Endothelial Growth Factor - therapeutic use; Recombinant Fusion Proteins - therapeutic use; Retina; Retina - diagnostic imaging; Retina - pathology; Retinal pigment epithelium; Retinal Pigment Epithelium - pathology; Retrospective Studies; Subretinal Fluid; Surgery; Surgical Oncology; Tomography, Optical Coherence - methods; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity - physiology; Wet Macular Degeneration - diagnosis; Wet Macular Degeneration - drug therapy; Wet Macular Degeneration - physiopathology
• ISSN: 0950-222X; 1476-5454; 1476-5454
• DOI: 10.1038/s41433-024-03087-0

Purpose To describe the prevalence of subretinal transient hyporeflectivity (STHR) in exudative neovascular age-related macular degeneration (nAMD) and its response to a loading phase of aflibercept. Methods Optical coherence tomography (OCT) scans of treatment-naïve nAMD patients captured at baseline and after a loading phase of aflibercept were graded for presence of STHR, defined as a small, well-defined, round, subretinal, hyporeflective area, delimited between the ellipsoid zone (EZ) and the retinal pigmented epithelium/Bruch membrane complex. OCT parameters recorded were macular neovascularisation (MNV) subtypes, location of retinal fluids (subretinal fluid, SRF and intraretinal fluid, IRF), central retinal and choroidal thickness. Response was defined as absence of IRF and SRF. Factors associated with completely resolved STHR versus persistent STHR post-loading phase were compared. Results 2039 eyes of 1901 patients were analysed. STHR was observed in 79 eyes of 78 patients, with an estimated prevalence of 3.87% (95% CI 3.08–4.81%). STHR were seen in 44 type 1 MNV (56%), 27 with type 2 (34%), and 8 with type 3 (10%). At baseline, a total of 303 STHR were present, ranging between 1–22 per eye. The total number of STHR reduced significantly after the loading phase to 173 ( p  = 0.002). Complete disappearance of STHR was seen in 44 eyes (56%) and persistent STHR in the rest (44%). Conclusions STHR may represent a marker of low-grade exudation in nAMD eyes with good response to a loading phase of aflibercept. However, its potential role as an independent nAMD activity biomarker is limited as most resolve after the loading phase.