Characterization of subretinal hyperreflective material and short-term visual acuity in patients with neovascular age related macular degeneration after loading dose with antiangiogenics.

purposeThis study analyzes the morphological characteristics of subretinal hyperreflective material (SHRM) and its relationship with short-term visual outcomes in patients with neovascular age-related macular degeneration (nAMD) treated with anti-vascular endothelial grown factor (anti-VEGF) at the Fundación Oftalmológica Nacional between 2011 and 2017. METHODOLOGY: An analytical observational study was conducted on 65 treatment-naïve nAMD patients who initiated treatment between January 2011 and December 2017. Spectral-Domain Optical Coherence Tomography (SD-OCT) was graded to determine quantitative and qualitative SHRM characteristics. SHRM features and best corrected visual acuity (BCVA) were correlated before and after treatment, and associations between SHRM characteristics and BCVA improvement after the loading phase were analyzed.

resultsThe median age was 75.5 years (range 68-84), and 56.9% were women. Aflibercept was the most widely used anti-VEGF (40%). Median BCVA improved from 0.8 logMAR (range 0.5-1.2) to 0.7 logMAR (range 0.4-1) after treatment. At baseline, a significant correlation was found between worse BCVA and SHRM horizontal extension (r=0.7, p=0.001), low reflectivity (p=0.017), and undefined margins (p=0.037). SHRM characteristics associated with BCVA improvement after treatment included low reflectivity (p=0.048), non-homogeneity (p=0.048), smaller width (p=0.043), and the presence of the external limiting membrane (ELM) (p=0.002) and ellipsoid zone (EZ) (p=0.017).

conclusionSHRM features such as low reflectivity, non-homogeneity, reduced width, and the presence of ELM/EZ were associated with improved short-term visual outcomes. These findings provide insight into favorable short-term SHRM characteristics, which may help establish early treatment criteria and support its role as a prognostic biomarker. KEY MESSAGES: WHAT IS KNOWN : Neovascular age-related macular degeneration (nAMD) is a progressive disease that severely impacts vision if untreated. Subretinal hyperreflective material (SHRM) is a recognized biomarker on spectral-domain optical coherence tomography (SD-OCT) and has been studied as a predictor of long-term visual outcomes in patients treated with anti-VEGF therapy. WHAT IS NEW: This study evaluates SHRM characteristics and their relationship with short-term visual outcomes after the loading dose of anti-VEGF treatment.SHRM features such as low reflectivity, undefined borders, smaller horizontal extent, and the presence of external limiting membrane (ELM) and ellipsoid zone (EZ) are associated with early visual improvement. SHRM features such as low reflectivity, undefined borders, smaller horizontal extent, and the presence of external limiting membrane (ELM) and ellipsoid zone (EZ) are associated with early visual improvement. These findings suggest that SHRM morphology could serve as an early prognostic biomarker, potentially guiding treatment decisions for better visual outcomes.