Changes in neovascular lesion hyperreflectivity after anti-VEGF treatment in age-related macular degeneration: An integrated multimodal imaging analysis

Giuseppe Casalino, Francesco Bandello, Usha Chakravarthy

Research output: Contribution to journalArticle

Abstract

PURPOSE. To correlate presence of hyperreflective material (HRM) on spectral-domain optical coherence tomography (SD-OCT) with color fundus photography (CFP) in patients with different subtypes of neovascular age-related macular degeneration (n-AMD). METHODS. Retrospective assessments were made at baseline and months 1, 3, and 12 after initiation of treatment. At baseline, CFP images were graded for the presence of blood, fibrin and lipid exudates, and retinal angiograms for n-AMD subtype. At the four selected visits, SDOCT scans were graded for HRM type (well-defined or undefined) and location (subretinal, intraretinal, and subretinal pigment epithelium [RPE]), integrity of RPE, ellipsoid zone, and external limiting membrane (ELM). RESULTS. A total of 121 eyes with active n-AMD from 117 patients were included. At baseline, undefined HRM was strongly associated with fibrin on CFP (X2 = 39.87; P <0.001). The overall prevalence of HRM decreased from 85.9% at baseline to 52.9% by month 12. From baseline to month 12, undefined HRM decreased (53.7% vs. 7.4%, respectively) and well-defined HRM increased (32.2% vs. 45.5%, respectively). Sub-RPE HRM, which was infrequent at baseline, increased up to 30.6% by month 12. At month 12, eyes with no HRM had the best mean final best-corrected visual acuity (BCVA), and those with undefined HRM the worst. Multivariate regression analysis showed that ELM disruption at both baseline and month 12 was a negative predictive factor for final BCVA (P = 0.001 and P <0.001, respectively), whereas presence of subretinal fluid at month 12 and number of treatments were positive predictors for final BCVA (P = 0.007 and P = 0.041, respectively), but the covariates describing HRM did not reach statistical significance in these models. CONCLUSIONS. In eyes with n-AMD, location and morphology of HRM changed after anti-VEGF treatment, and differences were observed in the various choroidal neovascularization (CNV) subtypes. After anti-VEGF treatment, it was well-defined HRM in the sub-RPE space that was observed mostly.

Original languageEnglish
Pages (from-to)OCT288-OCT298
JournalInvestigative Ophthalmology and Visual Science
Volume57
Issue number9
DOIs
Publication statusPublished - 2016

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Multimodal Imaging
Macular Degeneration
Vascular Endothelial Growth Factor A
Photography
Visual Acuity
Color
Fibrin
Subretinal Fluid
Choroidal Neovascularization
Membranes
Optical Coherence Tomography
Exudates and Transudates
Therapeutics
Angiography
Multivariate Analysis
Epithelium
Regression Analysis
Lipids

Keywords

  • Color fundus photography
  • Hyperreflective material
  • Multimodal imaging
  • Neovascular age-related macular degeneration
  • Retinal angiography
  • Spectral-domain optical coherence tomography

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience

Cite this

@article{22661688c0054839b430d8d1f410eb1d,
title = "Changes in neovascular lesion hyperreflectivity after anti-VEGF treatment in age-related macular degeneration: An integrated multimodal imaging analysis",
abstract = "PURPOSE. To correlate presence of hyperreflective material (HRM) on spectral-domain optical coherence tomography (SD-OCT) with color fundus photography (CFP) in patients with different subtypes of neovascular age-related macular degeneration (n-AMD). METHODS. Retrospective assessments were made at baseline and months 1, 3, and 12 after initiation of treatment. At baseline, CFP images were graded for the presence of blood, fibrin and lipid exudates, and retinal angiograms for n-AMD subtype. At the four selected visits, SDOCT scans were graded for HRM type (well-defined or undefined) and location (subretinal, intraretinal, and subretinal pigment epithelium [RPE]), integrity of RPE, ellipsoid zone, and external limiting membrane (ELM). RESULTS. A total of 121 eyes with active n-AMD from 117 patients were included. At baseline, undefined HRM was strongly associated with fibrin on CFP (X2 = 39.87; P <0.001). The overall prevalence of HRM decreased from 85.9{\%} at baseline to 52.9{\%} by month 12. From baseline to month 12, undefined HRM decreased (53.7{\%} vs. 7.4{\%}, respectively) and well-defined HRM increased (32.2{\%} vs. 45.5{\%}, respectively). Sub-RPE HRM, which was infrequent at baseline, increased up to 30.6{\%} by month 12. At month 12, eyes with no HRM had the best mean final best-corrected visual acuity (BCVA), and those with undefined HRM the worst. Multivariate regression analysis showed that ELM disruption at both baseline and month 12 was a negative predictive factor for final BCVA (P = 0.001 and P <0.001, respectively), whereas presence of subretinal fluid at month 12 and number of treatments were positive predictors for final BCVA (P = 0.007 and P = 0.041, respectively), but the covariates describing HRM did not reach statistical significance in these models. CONCLUSIONS. In eyes with n-AMD, location and morphology of HRM changed after anti-VEGF treatment, and differences were observed in the various choroidal neovascularization (CNV) subtypes. After anti-VEGF treatment, it was well-defined HRM in the sub-RPE space that was observed mostly.",
keywords = "Color fundus photography, Hyperreflective material, Multimodal imaging, Neovascular age-related macular degeneration, Retinal angiography, Spectral-domain optical coherence tomography",
author = "Giuseppe Casalino and Francesco Bandello and Usha Chakravarthy",
year = "2016",
doi = "10.1167/iovs.15-18753",
language = "English",
volume = "57",
pages = "OCT288--OCT298",
journal = "Investigative Ophthalmology and Visual Science",
issn = "0146-0404",
publisher = "Association for Research in Vision and Ophthalmology Inc.",
number = "9",

}

TY - JOUR

T1 - Changes in neovascular lesion hyperreflectivity after anti-VEGF treatment in age-related macular degeneration

T2 - An integrated multimodal imaging analysis

AU - Casalino, Giuseppe

AU - Bandello, Francesco

AU - Chakravarthy, Usha

PY - 2016

Y1 - 2016

N2 - PURPOSE. To correlate presence of hyperreflective material (HRM) on spectral-domain optical coherence tomography (SD-OCT) with color fundus photography (CFP) in patients with different subtypes of neovascular age-related macular degeneration (n-AMD). METHODS. Retrospective assessments were made at baseline and months 1, 3, and 12 after initiation of treatment. At baseline, CFP images were graded for the presence of blood, fibrin and lipid exudates, and retinal angiograms for n-AMD subtype. At the four selected visits, SDOCT scans were graded for HRM type (well-defined or undefined) and location (subretinal, intraretinal, and subretinal pigment epithelium [RPE]), integrity of RPE, ellipsoid zone, and external limiting membrane (ELM). RESULTS. A total of 121 eyes with active n-AMD from 117 patients were included. At baseline, undefined HRM was strongly associated with fibrin on CFP (X2 = 39.87; P <0.001). The overall prevalence of HRM decreased from 85.9% at baseline to 52.9% by month 12. From baseline to month 12, undefined HRM decreased (53.7% vs. 7.4%, respectively) and well-defined HRM increased (32.2% vs. 45.5%, respectively). Sub-RPE HRM, which was infrequent at baseline, increased up to 30.6% by month 12. At month 12, eyes with no HRM had the best mean final best-corrected visual acuity (BCVA), and those with undefined HRM the worst. Multivariate regression analysis showed that ELM disruption at both baseline and month 12 was a negative predictive factor for final BCVA (P = 0.001 and P <0.001, respectively), whereas presence of subretinal fluid at month 12 and number of treatments were positive predictors for final BCVA (P = 0.007 and P = 0.041, respectively), but the covariates describing HRM did not reach statistical significance in these models. CONCLUSIONS. In eyes with n-AMD, location and morphology of HRM changed after anti-VEGF treatment, and differences were observed in the various choroidal neovascularization (CNV) subtypes. After anti-VEGF treatment, it was well-defined HRM in the sub-RPE space that was observed mostly.

AB - PURPOSE. To correlate presence of hyperreflective material (HRM) on spectral-domain optical coherence tomography (SD-OCT) with color fundus photography (CFP) in patients with different subtypes of neovascular age-related macular degeneration (n-AMD). METHODS. Retrospective assessments were made at baseline and months 1, 3, and 12 after initiation of treatment. At baseline, CFP images were graded for the presence of blood, fibrin and lipid exudates, and retinal angiograms for n-AMD subtype. At the four selected visits, SDOCT scans were graded for HRM type (well-defined or undefined) and location (subretinal, intraretinal, and subretinal pigment epithelium [RPE]), integrity of RPE, ellipsoid zone, and external limiting membrane (ELM). RESULTS. A total of 121 eyes with active n-AMD from 117 patients were included. At baseline, undefined HRM was strongly associated with fibrin on CFP (X2 = 39.87; P <0.001). The overall prevalence of HRM decreased from 85.9% at baseline to 52.9% by month 12. From baseline to month 12, undefined HRM decreased (53.7% vs. 7.4%, respectively) and well-defined HRM increased (32.2% vs. 45.5%, respectively). Sub-RPE HRM, which was infrequent at baseline, increased up to 30.6% by month 12. At month 12, eyes with no HRM had the best mean final best-corrected visual acuity (BCVA), and those with undefined HRM the worst. Multivariate regression analysis showed that ELM disruption at both baseline and month 12 was a negative predictive factor for final BCVA (P = 0.001 and P <0.001, respectively), whereas presence of subretinal fluid at month 12 and number of treatments were positive predictors for final BCVA (P = 0.007 and P = 0.041, respectively), but the covariates describing HRM did not reach statistical significance in these models. CONCLUSIONS. In eyes with n-AMD, location and morphology of HRM changed after anti-VEGF treatment, and differences were observed in the various choroidal neovascularization (CNV) subtypes. After anti-VEGF treatment, it was well-defined HRM in the sub-RPE space that was observed mostly.

KW - Color fundus photography

KW - Hyperreflective material

KW - Multimodal imaging

KW - Neovascular age-related macular degeneration

KW - Retinal angiography

KW - Spectral-domain optical coherence tomography

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U2 - 10.1167/iovs.15-18753

DO - 10.1167/iovs.15-18753

M3 - Article

AN - SCOPUS:84978511505

VL - 57

SP - OCT288-OCT298

JO - Investigative Ophthalmology and Visual Science

JF - Investigative Ophthalmology and Visual Science

SN - 0146-0404

IS - 9

ER -