Subretinal Lipid Globules an Early Biomarker of Macular Neovascularization in Eyes With Intermediate Age-Related Macular Degeneration

Abstract

Purpose: To explore the association between subretinal lipid globules (SLGs) detected in eyes with intermediate age-related macular degeneration with the presence of nonexudative macular neovascularization.Methods: This was a retrospective analysis of 113 consecutive patients with bilateral intermediate age-related macular degeneration (226 eyes) followed for a least 6 months. All eyes underwent multimodal imaging with fundus autofluorescence, spectral-domain optical coherence tomography, and optical coherence tomography angiography. Subretinal lipid globules were identified on spectral-domain optical coherence tomography as round hyporeflective lesions measuring 31 to 157 mm located between the ellipsoid zone and the retinal pigment epithelium/Bruch membrane complex. Nonexudative macular neovascularization was detected with optical coherence tomography angiography. The features of NE-MNV lesions detected in eyes with SLGs were compared with those in eyes without SLGs.Results: Subretinal lipid globules were identified in 15 eyes of which 14 eyes (93.3%) demonstrated NE-MNV on optical coherence tomography angiography. In the remaining 98 eyes without SLGs, 18 (18.4%) displayed NE-AMD on optical coherence tomography angiography. The macular neovascularization area was larger in the SLG subgroup (+0.38 vs. +0.21 mm 2 , P = 0.008) and showed faster horizontal growth (+727 mm, CI 95% 250.4, 1,205.4) than MNV in eyes without SLGs (+64.9 mm, CI 95%, 24.3, 154) on optical coherence tomography B-scans. After a mean of 11.6 months, the conversion rate to exudative MNV was similar between eyes with SLGs and those without SLGs [8/26 (38.5%) versus 3/ 13 (27.3%), P = 0.56)]. Conclusion:The detection of SLGs in eyes with intermediate age-related macular degeneration was strongly correlated with the presence of NE-MNV. Although these MNV lesions were larger and grew faster than NE-MNV detected in eyes lacking SLGs, the rates of conversion to exudative MNV appeared similar.

Optical coherence tomography biomarkers in early and intermediate age‐related macular degeneration: A clinical guide

“…However, the conversion rates to neovascular AMD in both groups were similar. 51 In summary, given the evidence available up to date, the presence of SRLGs does not directly increases the risk of advanced AMD, but makes more likely to detect non-exudative neovascularization, which might be a predictor for exudation in a short time.…”

“…Lipid globules, choroidal caverns and sub‐retinal pigment epithelium globules are three terms describing the same type of lesions, lipid accumulation, with variable locations 49–51 . They appear as hyporeflective (optically empty) round spaces with a characteristic tail of hypertransmission seen on OCT (Figure 2, panels G,H).…”

“…Lipid globules, choroidal caverns and sub-retinal pigment epithelium globules are three terms describing the same type of lesions, lipid accumulation, with variable locations. [49][50][51] They appear as hyporeflective (optically empty) round spaces with a characteristic tail of hypertransmission seen on OCT (Figure 2, panels G,H). Choroidal caverns were first described by Querques et al as cavities occupying spaces devoid of vessels in the choroid in eyes with geographic atrophy.…”

Optical Coherence Tomography Angiography: A 2023 Focused Update on Age-Related Macular Degeneration

“…Furthermore, SLG was correlated to larger MNV size area and faster NE-MNV growth, being a growth predictor, as well. However, the rate of conversion from non-exudative to exudative state was similar, regardless of the presence of SLG [ 57 ]. Concerning the role of NE-MNV as a predictor of exudation, the growth in size of the neovascular lesion appeared to be a relevant activation biomarker [ 54 ], although both inactive and active MNV clearly increases over time [ 59 ].…”

Deep learning for automatic prediction of early activation of treatment naïve non-exudative MNVs in AMD

“…Several biomarkers for the prediction of exudation in NE-MNV have been proposed in the literature. 10,11 A recent meta-analysis identified as independent risk factors for progression to exudation in NE-MNV the presence of subretinal lipid globules, large MNV areas, rapid MNV growth, changes in pigment epithelium detachment (PED), the presence of branching patterns in the neovascular network, and the development of a hyporeflective halo around the MNV. 12 During the last decades, clinical applications of artificial intelligence have largely expanded, proving great performances in supporting clinical decision making, especially regarding imaging-based risk assessment.…”