Correlation Between Optical Coherence Tomographic Hyperreflective Foci and Visual Outcomes After Anti-Vegf Treatment in Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy

Lee, Hyungwoo; Ji, Bokjun; Chung, Hyewon; Kim, Hyung Chan

doi:10.1097/iae.0000000000000645

Cited by 40 publications

(30 citation statements)

References 24 publications

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“…Kang et al found that the number of HRF at baseline was inversely associated with final VA in patients with diabetic macular edema treated with intravitreal bevacizumab [ 23 ]. The same group reported similar findings in patients with branch retinal vein occlusion [ 8 ], neovascular age-related macular degeneration and polypoidal choroidal neovascular vasculopathy [ 24 ].…”

Section: Discussionmentioning

confidence: 64%

Behavior of hyperreflective foci in non-infectious uveitic macular edema, a 12-month follow-up prospective study

et al. 2018

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BackgroundHyperreflective foci have been described in OCT imaging of patients with retinal vascular diseases. It has been suggested that they may play a role as a prognostic factor of visual outcomes in these diseases. The purpose of this study is to describe the presence of hyperreflective foci in patients with non-infectious uveitic macular edema and evaluate their behavior after treatment.MethodsWe conducted a multicenter, prospective, observational, 12-month follow-up study. Inclusion criteria were age > 18 years and a diagnosis of non-infectious uveitic macular edema, defined as central macular thickness of > 300 μm as measured by OCT and fluid in the macula. Collected data included best corrected visual acuity, central macular thickness and the presence, number and distribution (inner or outer retinal layers) of hyperreflective foci. Evaluations were performed at baseline, and at 1, 3, 6, and 12 months after starting treatment.ResultsWe included 24 eyes of 24 patients. The frequency of patients with ≥11 hyperreflective foci was 58.4% at baseline, falling to 20.8% at 12 months. Further, hyperreflective foci were observed in the outer retinal layers in 50% of patients at baseline and just 28.6% at 12 months. Mean LogMAR visual acuity improved from 0.55 (95% CI 0.4–0.71) at baseline to 0.22 (95% CI 0.08–0.35) at 12 months (p < 0.001). Mean central macular thickness decreased from 453.83 μm (95% CI 396.6–511) at baseline to 269.32 μm (95% CI 227.7–310.9) at 12 months (P < 0.001). Central macular thickness was associated with number (p = 0.017) and distribution (p = 0.004) of hyperreflective foci.ConclusionsWe have observed hyperreflective foci in most of our patients with non-infectious uveitic macular edema. During follow-up and after treatment, the number of foci diminished and they tended to be located in the inner layers of the retina.

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Section: Discussionmentioning

confidence: 64%

Behavior of hyperreflective foci in non-infectious uveitic macular edema, a 12-month follow-up prospective study

et al. 2018

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“…The power of previous investigations has, however, been limited by the laborious quantification and poor reproducibility of the changes identified in the outer retinal bands. 35 Nevertheless, in an observation that lasted a minimum of 12 months after initiation of anti-VEGF therapy, the initial preservation of a foveal ELM was shown to be correlated with better final VA. 52 A retrospective study with a mean follow-up of 6 months showed that the length of disruption of the EZ at baseline correlated positively with the final VA. 53 Further, a posthoc analysis of CATT found the EZ was absent in the foveal center more often in eyes with underlying foveal SHRM. 49 However, analysis of the ELM alone did not reveal similar results.…”

Section: Risk Of Progressionmentioning

confidence: 98%

“…This feature of exudative disease also shows statistically significant reduction during anti-VEGF therapy. [51][52][53][54]…”

Section: Eyementioning

confidence: 99%

“…Analyses of the impact of the mere presence and location of hyperreflective foci on visual function at baseline and during therapy have revealed that a high amount (420) of hyperreflective foci and a location in the inner and subretinal layers are associated with worse VA outcomes. [52][53][54] Formation of a disciform scar via degradation and remodeling of extracellular space is the ultimate consequence of an untreated or treatment-resistant neovascular invasion, accompanied by loss of RPE and photoreceptors. 33 Photoreceptor integrity, naturally, is vital for visual improvement during anti-VEGF therapy.…”

Section: Risk Of Progressionmentioning

confidence: 99%

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A view of the current and future role of optical coherence tomography in the management of age-related macular degeneration

Schmidt‐Erfurth

Klimscha

Waldstein

et al. 2016

Eye

136

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Optical coherence tomography (OCT) has become an established diagnostic technology in the clinical management of age-related macular degeneration (AMD). OCT is being used for primary diagnosis, evaluation of therapeutic efficacy, and long-term monitoring. Computer-based advances in image analysis provide complementary imaging tools such as OCT angiography, further novel automated analysis methods as well as feature detection and prediction of prognosis in disease and therapy by machine learning. In early AMD, pathognomonic features such as drusen, pseudodrusen, and abnormalities of the retinal pigment epithelium (RPE) can be imaged in a qualitative and quantitative way to identify early signs of disease activity and define the risk of progression. In advanced AMD, disease activity can be monitored clearly by qualitative and quantified analyses of fluid pooling, such as intraretinal cystoid fluid, subretinal fluid, and pigment epithelial detachment (PED). Moreover, machine learning methods detect a large spectrum of new biomarkers. Evaluation of treatment efficacy and definition of optimal therapeutic regimens are an important aim in managing neovascular AMD. In atrophic AMD hallmarked by geographic atrophy (GA), advanced spectral domain (SD)-OCT imaging largely replaces conventional fundus autofluorescence (FAF) as it adds insight into the condition of the neurosensory layers and associated alterations at the level of the RPE and choroid. Exploration of imaging features by computerized methods has just begun but has already opened relevant and reliable horizons for the optimal use of OCT imaging for individualized and population-based management of AMD-the leading retinal epidemic of modern times.

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“…[ 34 ] Studies have also suggested increased number of hyper reflective foci on SD-OCT as a predictive factor for poorer visual outcomes following treatment for PCV. [ 35 ] These hyper reflective spots are non-specific biomarkers caused by migration of intraretinal microglial cells representing on-going inflammation and are also seen in patients with other retinal vascular diseases including diabetic macular edema and retinal vein occlusion. [ 36 ]…”

Section: Diagnosis Of Pcvmentioning

confidence: 99%

Current management strategy of polypoidal choroidal vasculopathy

Lai

2018

Indian J Ophthalmol

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Polypoidal choroidal vasculopathy (PCV) is a retinal disorder commonly found in Asians presenting as neovascular age-related macular degeneration and is characterized by serous macular detachment, serous or hemorrhagic pigment epithelial detachment, subretinal hemorrhage, and occasionally visible orange-red subretinal nodular lesions. PCV is diagnosed using indocyanine green angiography (ICGA), and the lesions appear as polypoidal aneurysmal vascular lesions with or without abnormal branching vascular network. Although ICGA remains the gold standard for the diagnosis of PCV, various imaging modalities have also facilitated the diagnosis and monitoring of PCV. Recent advances in imaging technology including the use of high resolution spectral domain optical coherence tomography (OCT) and OCT angiography have provided new insights on the pathogenesis of PCV, suggesting a link between PCV and pachychoroid spectrum of macular disorders. With the evolving understanding on the pathogenesis and clinical characteristics of PCV, different therapeutic options have been proposed. These include intravitreal anti-vascular endothelial growth factor (anti-VEGF) monotherapy, combination therapy with anti-VEGF and verteporfin photodynamic therapy, and thermal laser photocoagulation. In recent years, major multi-center randomized clinical trials such as EVEREST, EVEREST II, and PLANET studies have been conducted to compare the efficacy and safety of various treatment options for PCV. This review aims to summarize the results of recent literature, clinical trials and studies to provide an update on the management options of PCV. An overall management strategy for PCV will also be proposed.

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Correlation Between Optical Coherence Tomographic Hyperreflective Foci and Visual Outcomes After Anti-Vegf Treatment in Neovascular Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy

Abstract: The number of HF at subretinal layer on spectral domain optical coherence tomography at baseline might predict the final visual acuity after treatment in nAMD and PCV.

Cited by 40 publications

References 24 publications

Behavior of hyperreflective foci in non-infectious uveitic macular edema, a 12-month follow-up prospective study

Behavior of hyperreflective foci in non-infectious uveitic macular edema, a 12-month follow-up prospective study

A view of the current and future role of optical coherence tomography in the management of age-related macular degeneration

Current management strategy of polypoidal choroidal vasculopathy

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